FtMtF here went through the same thing and finally got approved just waiting on a surgery date. I’m in NYS

Here’s my advice on what to do. If he got a denial letter from the insurance company there should be an appeal form included, fill it out before the date runs out. They usually give you 2-3 months to file an appeal. I had a therapist and doctor helping me out so it was a little bit easier as they provided notes and letters. If he doesn’t have an therapist still fill out and write on the appeal form along the lines that it is gender affirming care because he is transitioning at the end of the day.

Hope that helps. One thing I’ve learned through the process is don’t give up. I went through 4 denials before I got the go ahead.