Cass Smith-Collins’ Struggle for Gender-Affirming Surgery Coverage
Cass Smith-Collins recently made headlines after undergoing gender-affirming surgery to match his chest with his gender identity. The decision came after years of psychological distress caused by the mismatch between his sex assigned at birth and his true gender. However, what should have been a celebratory moment turned into a financial nightmare for Smith-Collins.
Despite having in-network options available, Smith-Collins decided to go out-of-network with Florida-based surgeon, Charles Garramone, to ensure the best possible care. This decision came at a cost, as Smith-Collins had to pay approximately $14,000 upfront for the surgery. While he received prior authorization from his insurer, UnitedHealthcare, the reimbursement he expected after the surgery never came.
The surgeon billed a total of $120,987 to both the patient and insurance, but UnitedHealthcare only paid a portion of the claim initially, leaving Smith-Collins in a dire financial situation. It was only after media intervention that the insurer reprocessed the claim and increased its payment, providing a partial reimbursement to the patient.
This case highlights the confusion and complexity surrounding insurance coverage for out-of-network care. Patients like Smith-Collins may unknowingly sign financial agreements that leave them vulnerable to unexpected costs. Experts suggest consulting a lawyer before signing any agreements, understanding prior authorization letters from insurers, and seeking clarity on what “covered” truly means in terms of payment.
To avoid similar situations, patients are encouraged to request insurers to define coverage terms, ask for cost estimates, and inquire about refundable upfront payments if insurance covers the costs. Providing comprehensive information and clarity on insurance coverage and costs can help patients make informed decisions and avoid unexpected expenses when seeking out-of-network care.
