If you believe you've been unfairly denied coverage for medical services:
Senate Bill 5313
This law requires state-regulated insurance to cover gender-affirming care.
"In Washington State, the Gender Affirming Treatment Act (Senate Bill 5313), effective January 1, 2022, mandates that health insurance plans cover medically necessary gender-affirming treatments. This legislation prohibits insurers from denying coverage for such treatments if they are deemed medically necessary by a qualified healthcare provider. "
The Shield Law
This law protects access to gender-affirming treatment and reproductive health care services.
Uniform Disciplinary Act (UDA)
This law states that health care provider participation in gender-affirming treatment does not constitute unprofessional conduct.
Insurance coverage
Health insurers cannot refuse to issue, renew, or cancel coverage based on gender identity.
Health insurers cannot apply categorical cosmetic exclusions to gender-affirming treatment.
Health insurers cannot issue adverse benefit determinations that deny or limit access to gender-affirming treatment.
In order to get coverage you’ll need a pre-authorization and a doctors note. Find the brochure and instructions below:
An example of an appeal letter can be viewed below from the Office of the Insurance Commissioner of WA Sate:
Examples of covered treatments include:
Hormone therapy
Counseling services
Mastectomy and chest reconstruction
Breast augmentation
Hair removal procedures
Gender-affirming facial procedures
Tracheal shaves
Insurance Covered Treatments
*We do not offer all of the above services. A&E only offers electrolysis. Contact us for recommendations for other services.
If you plan to file claims with your insurance company, please let us know. We're happy to provide you with super bills that include diagnostic and procedure codes, along with our provider information, to assist you in reimbursement.
If your insurer denies services, they must provide you with a reason for the denial. The denial must be reviewed by a health provder with gender-affirming treatment experience. Insurers must use evidence-based clinical review criteria for prior authorization of treatment and services.
File a complaint with the Washington State Insurance Commissioner if you experience ongoing issues or discrimination with your insurance provider.
If you need additional help navigating insurance for us or other types of care, finding other types of providers, or booking appointments for all types of gender-affirming care; please reach out to Flourish Advocacy LLC below:
If you have questions or requests specifically for us about insurance reimbursement for our services please contact Yosh: