CONSULTATION: Letters are not required, but recommended for the consultation.

 

REVISION CONSULTATIONS: Most insurance companies do require copies of the original recommendation letters in order to process the surgery authorization. We will discuss this with you upon scheduling. 

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SURGERY SCHEDULING: In order to secure a surgery date, you will need to submit the letter requirements indicated below. If you submit your letters prior to your consultation, please be advised that they must be dated within 6-12-months of your surgery and will need to be revised.

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LETTER REQUIREMENTS:

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• 1 letter from your prescribing hormone provider

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• 2 mental health letters from two separate mental health providers

      (qualified mental health providers with a doctoral or master's level degree; PhD, MD, PsyD,             LCSW, MSW, MFT, DSW, APRN, NP, LPC)

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PLEASE SEE THE BELOW DOCUMENTATION THAT SHOULD BE INCLUDED IN YOUR LETTERS:

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Mental Health Letters Must Include:

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• Date the letter was written

• Patient's legal and preferred name

• Patient's date of birth (individual must be 18 years of age)

• The duration of the provider/patient relationship and frequency of treatment

• Statement that the patient has been diagnosed with persistent, well documented gender dysphoria.

• The patient has the capacity to make a fully informed decisions and consent for treatment.

• The patient has undergone a minimum of 12 months of continuous hormone therapy*

• Documentation that the patient has completed a minimum of 12 months of successful continuous full time real-life experience in the new gender, across a wide range of life experiences and events that may occur throughout the year. 

• If the patient has significant medical/mental health or substance abuse issues present, they must be reasonably controlled. 

• The patient understands the long-term follow up requirements and post-operative expectations have been addressed.

• Fertility preservation has been discussed with the patient.

• The provider writing the letter must state their experience treating patient's diagnosed with gender dysphoria.

• The letter must be signed by the mental health provider.

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Hormone Letter Must Include:

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• Date the letter was written

• Patient's legal and preferred name

• Patient's date of birth

• The duration of the provider/patient relationship

• Date the hormone therapy began; minimum of 12 months of continuous hormone therapy*

        

* If you are not taking hormones due to a medical contraindication or personal choice, we require a letter from your primary care provider documenting this information.

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* Please make sure ALL letters are signed and dated by your providers

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* Please be aware that some insurance companies may have different letter requirements not listed above​​

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*We are aware of the WPATH SOC8 that was recently released. However, we are currently following SOC7 since insurance companies take time to update their requirements.

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