Before scheduling your consultation, we need to know if you will be proceeding with insurance or not – if not, you will be an out-of-pocket client.
We are prepared to assist you with the insurance authorization process. We can offer ALL of our procedures if you have the right benefits in your insurance to help cover the costs. If you don’t have any insurance or don’t have the appropriate coverage within your insurance plan, we can offer SOME of our procedures at out-of-pocket pricing.
The following information informs you of the importance of providing us with the most up-to-date information about you. Please submit a request through the Contact Us tab to start your process.
We perform a Benefit Check on all insurance plans clients provide to see if the plan will cover treatment for Gender Dysphoria and the associated surgery you requested. Benefit checks can take an extended amount of time depending on our waitlist and your insurance’s ease of use. If there is appropriate coverage, we will then move on to the next step of obtaining your WPATH referral letter(s) and scheduling your initial consultation to meet Dr. Gallagher. We will bill your insurance for your consultation fee, but you may be asked to pay your “specialty co-pay” at the time of your consultation. After your consultation, your surgery request will be sent for a Pre-Determination or Prior Authorization for services. All WPATH letters and any other tests or documents Dr. Gallagher orders MUST be completed before this process can begin. Your surgery will not be scheduled until the insurance has given approval that your case meets their medical policy and they issue authorization. This process can take up to 90 days.. Your patience and understanding is appreciated while we work on your case. If there is not appropriate coverage, we would not be able to appeal to have it added. You would have to petition the employer that offers insurance to add Gender Confirmation Surgery to covered benefits in order to use that coverage for your surgery.
If you do not have insurance or if your benefit check determines your insurance does not cover this procedure, we can work with you to pay out-of-pocket.
A consultation fee for out-of-pocket procedures is $150. This is non-refundable, but will be put toward your surgical costs upon billing. It will be due at checkout during your consultation.
With all Out-of-Pocket costs, you will be required to pay all fees upfront and in full 2 weeks before your scheduled surgery.
We are currently not able to offer you payment plans or financing here. You are welcome to do obtain financing outside of our office to fund your payments.
The fees associated with out-of-pocket procedures are listed here. Not all feess are applicable to each procedure, but may be applied and will be discussed on a case-by-case basis:
In the medical community and within Plastic Surgery, Out-of-Pocket procedures are often deemed cosmetic. This does not mean that we don’t agree that they are medically necessary for you, but the jargon associated with these procedures will appear on some forms and information you will received as they legally need to be stated as such for us to show the accurate pricing discounts.
The following is a list of procedures that we can offer out-of-pocket:
At this time we are unable to offer the following procedures as OOP:
Scheduling your surgery date is based on either your insurance being approved or if you are Out -of-Pocket, having financing secured and being ready to pay.
Dr. Gallagher is typically booked 2-3 months out for surgery. Dates will be given on a first approved/ first-come-first-serve basis. The sooner you contact us back once we reach out about a surgery date, the sooner you will be able to secure a surgery date.
If your schedule will not allow for this timeline, please let us know any important details about your insurance including it terming (ending), plans to move, or inability to take the necessary time off to recover. The more we know about your situation, the more we can try and work with you. If we cannot accommodate your timeline or needs, we will ask that you contact us again in the future when you are ready to complete the entire process.
If you are moving forward as an out-of-pocket patient, surgery scheduling is slightly different. Once we have seen you for your initial consultation and Dr. Gallagher and you agree to move forward with surgery, you will be given a quote on surgery costs and you will need to secure payment and/or financing to pay for your surgery. Out-of-pocket procedures can sometimes be scheduled 30+ days out from your initial consultation based on Dr. Gallagher’s schedule availability and yours. Once a surgery date is agreed upon, you will be sent official documents about all costs and who, how, and when to pay.
It is important to know that if you choose to move forward with an out-of-pocket procedure, you will NOT be able to go back and appeal to your insurance for repayment or authorization. You will be asked to sign a Financial Responsibility Statement advising that once payment is received and the procedure is completed, all other options for coverage will be waived.
There are several other items that can cause a delay in surgery scheduling. The following are common occurrences in delaying surgery scheduling:
Not stopping smoking. You will be required to be smoke-free for several weeks (to be determined by Dr. Gallagher) before surgery. You will be given a nicotine test and should you fail, surgery would be cancelled and not rescheduled until you pass.
Hair removal completion. If your surgery requires hair removal to be completed prior to a procedure, we cannot schedule surgery until that has been confirmed.
Required weight loss goal not met. Some of our procedures will require you to lose weight and lower your BMI before it will be considered safe for you to undergo surgery. Surgery cannot be scheduled until this goal has been met.
Not maintaining proper health. If you have secondary health conditions such as diabetes, anemia, weight gain in excess, etc., we may have to delay your surgery at any time.