FAQ: Surgery Coverage under MIT Health Plans

The chart below is intended to provide general information on services that are covered by health insurance. Note that certain covered services require an initial out-of-pocket payment that is later reimbursed. For complete details, see Gender Affirming Services [PDF] from Blue Cross Blue Shield of Massachusetts. Students may contact the MIT Student Insurance Office at stuplan@med.mit.edu and employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151 for more information.

You should begin by discussing your plans with your primary care provider (PCP), reviewing the Blue Cross Blue Shield of Massachusetts (BCBSMA) guidelines for surgery, and selecting a surgeon. If you haven’t already found a surgeon, your PCP can provide recommendations.

Once you have found a surgeon, confirm that they will accept BCBSMA insurance. Some surgeons do not accept insurance coverage and may require that patients pay for care out of pocket.

After you’ve confirmed that the surgeon accepts BCBSMA insurance, ask your PCP to submit a referral to that surgeon. Once the referral is approved, you may schedule an appointment for a surgical consultation. Depending on the type of surgery, the surgeon may need letters from your PCP and/or a mental health provider attesting that the surgery is “medically necessary” Surgical letter requirements are detailed in the BCBSMA guidelines. Once the surgeon has agreed to proceed with surgery, the surgeon must submit a request for coverage for the surgery directly to BCBSMA.

There are surgeons who perform gender-affirming surgery at several hospitals in Massachusetts:

• Massachusetts General Hospital Transgender Health Program
• Boston Children’s Hospital Gender Multispecialty Service (GeMS)
• Boston Medical Center Transgender Medicine and Surgery
• Beth Israel Deaconess Medical Center Gender-Affirming Services

Your PCP can provide recommendations.

Based on type of surgery, your surgeon may require letters of medical necessity from your PCP and/or a licensed mental health clinician before they can submit the request for coverage to Blue Cross Blue Shield of Massachusetts (BCBSMA). Surgical letter requirements are detailed in the BCBSMA guidelines. If you received mental health care before coming to MIT, give your previous mental health provider a copy of the BCBSMA guidelines and ask them to write the letter. If you haven’t already seen a mental health provider who can provide this letter, you can see a provider in MIT Medical’s Student Mental Health and Counseling Services.

Students may contact the MIT Student Insurance Office at stuplan@med.mit.edu and employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151. They will either answer your questions or direct you to someone who can provide answers. Do not contact the MIT Medical Billing Office with questions about insurance coverage.

Sometimes you might need to call Blue Cross Blue Shield of Massachusetts (BCBSMA) to get an answer. If you call BCBSMA, make sure to tell them you are from MIT, so they can refer to MIT’s coverage guidelines. Always ask for the name of the person you speak to and get a reference number for your conversation. Write this information down in case you need to refer to it in the future.

There is limited coverage for sperm banking and egg freezing. Associated costs such as STD screening and semen analysis will be covered by your insurance and can be done at MIT Medical.

There are several sperm banks in the area. The one closest to MIT and most frequently used by MIT is New England Cryogenic Center. Egg freezing must be done by a reproductive endocrinologist (fertility specialist). The fertility group in this area with the most experience caring for transgender persons is IVF New England.

For questions about medical care, contact Colleen McDonald, N.P.

For specific questions about benefits or insurance claims, Students may contact the MIT Student Insurance Office at stuplan@med.mit.edu and employees may contact MIT Benefits at benefits@mit.edu or call 617-253-6151.