Before scheduling your initial consultation, we will need some information from you to determine what kind of patient you will be…insurance or out-of-pocket.
We know how confusing it can be to try and figure out what your insurance will and won’t cover for you. We can help with that! 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 is meant to give you some background on what we will need to help you through this process in either category. You can send us a request through the Contact Us tab to start the process of becoming a patient with Dr. Gallagher.
We perform a Benefit Check on all insurance plans that we are contacted with to see if the plan will cover treatment for Gender Dysphoria, from there we ask about what kind of coverage is allowed for surgical intervention of gender dysphoria. Benefit checks can take an extended amount of time to complete depending on our waitlist and your insurances ease of use. We will let you know when to expect an update. 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 with 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 to your insurance 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 takes on average 30-90 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, contacting the employer that offers the insurance and advising that you would like to see the benefit for ‘gender confirmation surgery’ added to your plan is the best way to see progress in your benefits.
If you do not have insurance or your benefit check determines your insurance does not cover this procedure we can offer this an out-of-pocket surgery.
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: