In order to get scheduled for surgery, please send us a surgery application and non-refundable $1000 deposit. Do not send insurance information or letters of recommendation at this time.
We accept most major commercial insurance plans, and are in network with Cigna, Blue Shield, Anthem BCBS PPO, and United Healthcare. If you do not have insurance, we ask you to pay in full for the surgeon, OR and anesthesia costs 3 weeks prior to your date of surgery. If you would like to know the cost of a specific type of visit or surgery, you may call us at any time at 650-570-2270.
For Office Visits, Please bring your insurance ID card to your office visit. If there is a co-payment for your office visit, you will be expected to pay this at the time of your visit. Most annual exams are covered without co-pay so please let us know if this is the specific reason for your visit with us. We accept all major credit / debit cards, cash or personal checks.
For Surgical Fees, our pre-authorization process can help you to know exactly how much your co-payment might be expected to cost. See below for details.
Medicare
Despite years of efforts with Medicare, we have been unable to contact any Medicare personnel who can guarantee approval and reimbursement. In our test cases, there have been continual denials of our claims, and eventually we withdrew from Medicare. However, our hospital and anesthesia group are contracted with and accepting Medicare for transgender surgery, and have successfully submitted claims. This means that while you will need to pay the self-pay rate to our office prior to surgery, the hospital and anesthesia group will not require payment up front, and will bill Medicare. You will still need to provide two strong letters of recommendation which will be submitted to Medicare by the hospital following your surgery. Please contact our office with questions.
Medicaid/Medi-Cal
We are sympathetic to those with Medicaid. We believe in access for all. However, due to the lengthy and often arduous process necessary for pre-authorization, we are not contracted with MediCal (California state Medicaid), or any MediCal managed plans, other than San Francisco Health Plan. We are not contracted with any out of state Medicaid or Medicaid managed plans.
Commercial Insurance
More and more insurance companies are covering Gender Affirming Surgeries. After many years, the process is becoming easier. We will work to pre-authorize your surgery. This means that if your insurance company covers Gender Affirming Surgeries, you will only have to pay your coinsurance up front. We will do the leg work, and help you through this often daunting process. We are in network with most major insurance companies, and those that we are not in network with will often work with us, including Aetna, as there are so few surgeons who perform this procedure. We are experts regarding getting Gender Affirming Surgeries covered by insurance… let us help!
Pre-Authorization
Before we start a pre-authorization for you, please check the Specific Exclusions section of your insurance plan and see if Transgender Surgery, Genital Reassignment Surgery, etc., is listed as an exclusion. If it is excluded, you’ll need to approach your employer and ask them to add the coverage to your insurance plan. We can provide letters of medical necessity which can be of help in nudging an employer to add transgender surgery to their current health plan.
If you don’t see that Transgender Surgery is specifically excluded or if you are unsure, we are happy to do an insurance authorization. We will start your pre-authorization about 6 months prior to your desired surgery date and/or as we see you’re nearing the top of the cancellation list.
Keep in mind that we tend to have quite a long waiting list for surgery. We do keep a cancellation list for patients who wish to get in sooner.
You can help us be successful in seeking pre-authorization by following the guidelines below:
- Send in your Surgery Application and non-refundable $1000 deposit in order to secure a surgery date and get onto our cancellation list. (The deposit is generally non refundable. However, if we are unable to pre-authorize your insurance after exhausting all options, and you are unable to pay out of pocket or secure new insurance, we will refund.) The $1000 will go toward your deductible. If your insurance pays at 100% you will be reimbursed. You should not send in the deposit if you have SFHP.
- 6 months prior to your surgery, or when you are contacted by our staff as you near the top of the cancellation list, we will ask you to complete and return some insurance forms, send enlarged and legible copies of the front and back of your insurance id card and recent letters of recommendation. Your insurance company will most likely require two letters of recommendation, one from a doctorate level therapist and the second from any licensed therapist. Letters should be recent, within six months of your surgery date, in order to meet insurance requirements. You will receive word from us when we hear from your insurance company, and they should send you a decision in writing as well.
If you have any questions, please do not hesitate to contact our office at (650) 570-2270!