(415) 530-5335 Menu

The process for beginning your surgical journey with Dr. Satterwhite or Dr. Gurujal 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.)

(415) 530-5335

© ALIGN SURGICAL ASSOCIATES INC. ALL RIGHT RESERVED. Designed & Developed by Studio III

PRACTICE POLICY UPDATE REGARDING COVID-19

View Update Virtual Consultation

We remain open to continue serving the transgender community

With the safety and well-being of our patients and staff as our highest goal, Dr. Satterwhite and Dr. Gurujal are determined to provide needed medical care and planning.

VIRTUAL CONSULTATIONS: we continue to be busy with phone and video visits providing access to all patients interested in gender confirming surgery

FOLLOW UPS: we continue to provide needed care for our existing patients by phone and video, and in person when medically appropriate

SURGERY: we are currently performing surgery with proper safety measures in place

Please do not hesitate to reach out to us with any questions. To the best of our ability, we pledge to keeping you safe, healthy, connected, and informed during COVID-19.

With best wishes, Your Align Surgical Team

Virtual Consultation


Align Surgical wants to know how we can help

We feel deeply for the disruption that coronavirus has likely caused to your lives. Amidst the restrictions in place, we realize that virtual consults, follow ups, and booking future surgical dates may not meet all your needs.

If there is more we can do for you as a medical practice, we want to know.

Please reach out and let us know other ways we can help. We have set up points of contact at 415-530-5335 and [email protected] to hear your suggestions.

We are here to listen.

Schedule a Consultation

Send Us A Message