Andrea LaBarbera

5 Country Club Dr
Ledyard CT 06339

Grievances and Appeals,

P.O. Box 105568
Atlanta GA 30348-5568

11/17/2017
RE: Appeal of non-certification for services requested
Patient: Andrea LaBarbera
Reference No: 0254048828
Provider: John Persing
Facility/Vendor: Yale New Haven Hospital
Patient Date of Birth: 12/17/1988
Insurance Identification Number: DOMAN6266071

To Whom it May Concern:

I, Andrea LaBarbera, born December 17, 1988, am writing this letter as my statement of appeal to a decision of
non-certification I received for a facial feminization surgery, reference no: 0254048828. Services listed are medically
necessary and a denial of services is discriminatory. I have been diagnosed with gender dysphoria (gender identity disorder
in adulthood and adolescence, transsexualism), the distress associated with the self-perceived incongruence of one's own
sex and gender. Facial feminization surgery is a combination of facial reconstructive surgeries aimed at alleviating the
distress caused by mental illness, gender dysphoria.
Both the World Professional Association for Transgender Health (WPATH) and my current plan define sex
reassignment surgery as not a single procedure. WPATH suggests a triadic approach to treating the symptoms of gender
dysphoria through hormonal replacement therapy, a real life experience, and surgical intervention. Through their standards
of care gender dysphoria can effectively be cured. Non-genital surgeries are frequently performed in order to treat gender
dysphoria as WPATH admits these surgeries (including facial feminization surgery) can effectively be of more importance
than genital surgery to the individual's own treatment plan for sex reassignment surgery.
Any surgery aimed at meaningfully treating illness is considered medically necessary. It has been shown that
transgender related surgeries are meant to treat the mental illness. Gender dysphoria is an accepted mental illness in the
Diagnostic and Statistical Manual of Mental Illness (DSM-5). I have complied with the standards of care as they have
evolved over the years. I underwent a multitude of psychotherapy. I began hormonal replacement therapy in 2007. My real
life experience is considered to have officially started in 2008 when I had a legal name change for the purpose of better
assimilating into the workforce. My first surgical intervention was last year (2016) when I had an orchiectomy performed.
After having exhausted other avenues I still feel an incredible amount of distress from my gender dysphoria. Facial
feminization surgery would greatly alleviate the distress I experience as a result of my gender dysphoria. Formerly
permissible exclusion surrounding transgender surgeries have been found to be discriminatory and non-compliant with the
Affordable Care Act. I strongly urge for compliance with the ACA and benefit coverage.

Sincerely,

Andrea LaBarbera
Sent via fax on 11/17/2017 to (877)-876-4992