To the Editor Canner et al1 reported that the number of gender-affirming surgeries performed in the United States has been increasing since 2000. To conduct this research, the authors identified hospitalizations for gender-affirming surgical procedures by the presence of diagnosis codes for either transsexualism or gender identity disorder within the discharge record. However, in the 2000s, clinicians avoided using these codes because insurance companies commonly implemented blanket exclusion policies prohibiting reimbursement for gender-affirming services. Instead, clinicians would often use a broader category of codes, such as unspecified endocrine disorder or unspecified disorder of genital organs, when caring for transgender individuals to prevent burdensome and invasive disputes between insurers and patients.
Arnold JD, Nelson AE, Loubier EM. Trends in Insurance Coverage for Gender-Affirming Surgeries. JAMA Surg. 2018;153(10):972. doi:10.1001/jamasurg.2018.2120
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