AG’s Office Reminds HEALTH CARE Providers that
GENDER-AFFIRMING Surgeries are Covered BY MassHealth
BOSTON – The AG’s
Office is reminding MassHealth providers that most aspects of gender-affirming
surgeries are covered by MassHealth and patients should not be billed
out-of-pocket for any portion of covered surgeries.
“We want to raise awareness among
both MassHealth patients, especially those from the transgender community, and
health care providers that patients cannot be required to pay out of pocket for
medical care that is covered by MassHealth, including gender-affirming
surgeries,” said AG Healey. “We hope that by bringing attention to this
matter, these surgeries become more accessible and affordable to those who need
them, and we commend Harvard Medical Faculty Physicians for their commitment to
that goal.”
In an agreement with the AG
Office’s, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical
Center, Inc. (HMFP) will reimburse MassHealth patients who were mistakenly
charged directly for the chest contouring portion of their gender-affirming
surgeries. HMFP will continue to provide this service to MassHealth patients,
with full coverage by MassHealth.
“As a physician group providing the
largest gender-affirming surgical service in New England, our commitment to
compassionately and equitably serving the health care needs of the transgender
community is deep and long standing,” said HMFP in a statement. “Working
collaboratively with the Massachusetts Attorney General’s office, HMFP
successfully achieved our shared goal to clarify coverage of this vital service
to ensure coverage for eligible MassHealth patients.”
The AG’s Office reminds health care
providers that MassHealth patients cannot be charged out-of-pocket payments for
most aspects of gender-affirming surgeries, including the chest contouring
portion of female-to-male “top” surgeries meant to treat their gender
dysphoria.
The HMFP
matter was handled by Assistant Attorney General Christina Chan and
Investigator Katie Suttmeier of the AG’s Medicaid Fraud Division, with
significant assistance from MassHealth.
The AG’s Medicaid Fraud Division
receives 75 percent of its funding from the U.S. Department of Health and Human
Services under a grant award. The remaining 25 percent is funded by the
Commonwealth of Massachusetts.
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