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The process for beginning your surgical journey with Dr. Satterwhite or Dr. Gurjala and the team at Align is simple and accommodating.

Insurance Information We Need:

Step One

Schedule a private consultation in the comfort of the Align Surgical San Francisco office. If an in-person consultation is difficult, then a phone consultation can be arranged.

Step Two

Obtain letters of support for your transition from mental health professionals and hormone prescribers you are working with. These should be dated within 1 year of the operation. If you have any medical conditions, then specific letters of medical clearance may need to be obtained, as well as labs and specific studies. We will advise you at your initial consultation.

Step Three

Mark your surgery date on your calendar.

Step Four

Our office and insurance team will begin the insurance authorization process at least 2-3 months prior to your surgery date.

Step Five

Receive your comprehensive surgical confirmation packet in the mail 30-60 days prior to your surgery with pre-operative and post-operative instructions.

Step Six

Pay your balance, if paying out of pocket.

Letter requirements:

Patients are required to obtain letters of support in order for us to request a prior-authorization for their surgery.

The required letters depend on the procedure:

  • Top Surgery, Breast Augmentation, and Facial Feminization procedures require 1 mental health letter from a licensed mental health provider.
  • Phalloplasty, Vaginoplasty, and any other bottom surgeries require 2 mental health letters from two different licensed mental health providers and 1 from your hormone provider.

We review letters based upon the insurance the patient has. We recommend patients reach out to their providers for revisions, if we notice that further clarification is needed.

See below for the letter requirements that we use for various insurance companies.

Process & Fees Information

The mental health provider letter(s) must include:

  • Patient’s legal and preferred name
  • Patient’s date of birth
  • Date provider/patient relationship began and frequency of contact
  • Statement that the patient has been diagnosed with persistent, well documented gender dysphoria and exhibits all of the following:
    • The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; and
    • The transgender identity has been present persistently for at least two years; and
    • The disorder is not a symptom of another mental health disorder; and
    • The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • Documentation that the patient has completed a minimum of 12 continuous months living within their identity across a wide range of life experiences and events that may occur throughout the year
  • The patient has undergone a minimum of 12 continuous months of hormone replacement therapy *
  • The patient is able to comply with long-term follow-up requirements and post-operative expectations have been addressed
  • Any substance use must be well controlled for at least 6 months prior to the patient’s surgical date
  • Statement that the patient has the capacity to make fully informed decisions and to consent for treatment
  • If the patient has significant medical or mental health issues present, they must be reasonably well controlled
  • The provider writing the letter must state their experience with treating patients diagnosed with gender dysphoria

*If you are currently not on hormones due to any contraindication or do not take hormones, please have your therapist or primary care physician note this in a letter.

The hormone provider letter must include:

  • Patient’s legal and preferred name
  • Patient’s date of birth
  • Date provider/patient relationship began and frequency of contact
  • Date hormone therapy began and frequency of treatment
  • The patient has completed a minimum of 12 continuous months of hormone therapy

*If you are currently not on hormones due to any contraindication or do not take hormones, please have your therapist or primary care physician note this in a letter.

(Please note, some insurance companies have additional letter requirements other than above.)

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