FAQ: Surgery Coverage under MIT Health Plans
The information in this FAQ applies to individuals with the MIT Student Extended Insurance Plan, the MIT Affiliate Extended Insurance Plan, or one of the MIT employee health plans. This FAQ does not apply to individuals who have coverage only through the MIT Student Medical Plan or the MIT Affiliate Medical Plan.
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 on your own, your PCP can provide recommendations.
Once you have found a surgeon, confirm that he or she 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 you’ve chosen 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. The surgeon will need letters from your PCP and a mental health provider attesting that the surgery is “medically necessary” as 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.
- Breast surgery: There are several surgeons in Massachusetts who perform breast surgery for transgender patients. Your PCP can provide recommendations.
- Genital surgery: There are no surgeons in Massachusetts who perform genital surgery. You might consider one of the following out-of-state surgeons from the below list provided by Fenway Health. This list is provided for informational purposes only. MIT Medical does not endorse any of these providers.
Blue Cross Blue Shield of Massachusetts insurance payments may not cover the full fee charged by the surgeons listed above. You must verify coverage individually with any surgeon you select.
Before your surgeon can submit the request for coverage to Blue Cross Blue Shield of Massachusetts (BCBSMA), he or she will require letters from your PCP and a licensed mental health clinician that include the details specified in the BCBSMA guidelines. If you received mental health care before coming to MIT, provide your previous mental health provider with a copy of the BCBSMA guidelines and ask that provider to prepare 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 Mental Health and Counseling Service.
Insurance will not cover travel expenses for out-of-state care, sperm banking, or egg freezing.
Contact Member Services at email@example.com or 617-253-5979. 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.
The cost of sperm banking and egg freezing are not covered by insurance. However, 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 California Cryobank. Egg freezing must be done by a reproductive endocrinologist (fertility specialist). is The fertility group in this area with the most experience caring for transgender persons is IVF New England.