Insurance Coverage
To find out if your insurance covers gender affirming medical and surgical services, you need to ask if you have benefits or coverage for transgender/gender dysphoria. You will also need to ask if both the provider AND the facility are in network for your plan.
Prior Authorization
We will need prior authorization from your insurance company before we begin any gender affirming surgery services. Insurance companies use the prior authorization process to ensure that your surgery is covered. This process can take up to six months depending on your insurance provider. You should call your insurance for updates directly.
For any questions about the prior authorization process for bottom surgery, please call us at 801-213-2195, option 4. For all other plastic surgery services press option 3. If you reach our voicemail, please leave your:
- name,
- phone number, and
- date of birth.
Out-of-Network Plans
If our providers are not in-network, ask your insurance company if you would qualify for a gap exception. A gap exception can sometimes be granted as a covered service if there are no other in-network providers in the area who offer that service. Check our insurance information to verify whether University of Utah Health is in your network of coverage.
Please note that we are actively working with all of the payers in Utah to advocate for medically necessary care as a covered benefit.
Your Responsibilities During the Insurance Process
Although our teams will submit the prior authorization to your insurance for coverage, you are responsible for the following:
- Ensuring we have all the required items for the prior authorization, such as the letter(s) of support.
- Checking in with your insurance company for updates.
- Finding out your benefits, out of pocket maximum, and other insurance coverage questions.
How to Be Your Own Health Insurance Advocate
Finding your Out-of-Pocket Estimate with Insurance or a Self-Pay Estimate
Visit our pricing page to see all the out of pocket and self-pay costs for our services. You do not need a MyChart account to see an estimate.
Once you are on the MyChart Patient Estimates page, click on the box labeled “Gender Affirmation.”
For each procedure or service, you can click on the insurance options to obtain an out of pocket estimate with your insurance OR click “skip this step” to see the self-pay price without insurance. Note some services are self-pay pricing only; other services allow quotes for both self-pay and with insurance.
Most services qualify for a 30 percent discount if you are self-pay. Other out of pocket costs may include medications, labs, and pre and post-operative supplies.
Self-Pay for Surgery
If you are using self-pay for surgery, you will need to pay the total fee in full by the scheduled date of your surgery. We accept all major credits cards. You can also use third party financing to pay for your surgery.
Please reach out to our team if you have questions about a quote or pricing.
Call 801-213-2195 option 4 or email transgenderhealth@hsc.utah.edu.
BLISCare Insurance for Self-Pay Patients
If you don’t have health insurance and are paying for gender affirming bottom surgery on your own, you must purchase BLISCare insurance.
University of Utah Health's gender affirming surgery team are approved BLISCare surgeons. Becoming a BLIS Surgeon is a very selective process determined exclusively by BLIS. This means that we meet very high standards for short-term outcomes and long-term patient success.
Because we are approved by BLIS, we are able to participate in an innovative new insurance coverage which allows us to make a unique commitment to our self-pay patients:
- If you have a covered complication within a certain time frame after your surgery, you are not responsible for the costs associated with caring for that complication.
** This complication protection is only offered as part of the package price for your bottom surgery. We are happy to provide this benefit to our patients, easing your mind and your wallet in this important decision to have a life-saving surgery.
**Other terms and conditions apply. Please contact our office and review the self-pay contract for further details about this program.
Sign up for a Gender-Affirming Insurance Plan
To sign up for an insurance plan, visit Take Care Utah, a Utah Health Policy Project Initiative. Take Care Utah focuses on helping people sign up for health insurance free of charge. This includes both Medicaid and marketplace plans.
In addition, you can search under each insurance plan’s medical policy for transgender benefits to see if they provide gender affirming services.
Contact Ciara Mao (she/her) ciara@healthpolicyproject.org for more information.
Other Financial Resources
Find other financial resources, such as grants and other financial aid opportunities, with local and national community organizations.