Insurance

If you are a patient who has insurance, your out-of-pocket cost depends on whether or not we are in network with your insurance company. If we are in network, or the insurance company issued a benefit exception to consider your surgery in-network, we would bill your insurance and you would just be responsible for any patient cost-shares (deductibles, co-pays or co-insurance) as outlined by your insurance policy. We can provide an estimate of your cost share after our insurance coordinator has gotten prior authorization from your insurance provider.

If we are out of network with your insurance, we would require you to pay our compassionate care rate, which usually ranges from $10,350 to $13,050. We would give you a personalized quote at your consultation appointment. Our insurance coordinator would get prior authorization before your surgery and provide you with the necessary paperwork after surgery so you can submit to your insurance on your own to get reimbursed. Please be aware that the insurance would base any reimbursements on their allowable fees and the percentages based on your policy, so your reimbursement will be less than the fee you paid.

We are in network with Kaiser of Washington PPO Plan only. Please reach out to our office to get the process started. We will request prior authorization for the appointment, and once Kaiser has issued their authorization for a consultation, we would be happy to get you scheduled.

We follow WPATH standards even if you do not use insurance. If you are 18 years or older, we would require one letter from either your mental health provider or your PCP supporting you having this surgery. If you are younger than 18, we would require 2 letters, one from your mental health provider and one from your PCP.

Yes, if you are using insurance for your surgery, we would bill the consultation to your insurance, and you would be responsible for any patient cost-shares as outlined by your policy.

We want to make sure you are well informed before moving forward with surgery. If you think of any further questions after your initial consultation, we would be happy to schedule another appointment for you. Please be aware that this visit would be billed to your insurance just like your first consultation.

The compassionate care rate is a discounted rate for self-pay patients.

We are not sure if other surgeons have insurance coordinators available to their patients. Our mission is to educate and help patients as much as we can throughout the entire surgery process. We know that insurance can be daunting and scary. We want to make this process as easy as possible for our patients and ensure that patients have a specialized contact person at our office to assist with all of their insurance needs.

Please reach out to our office and our insurance coordinator Lucille would be happy to help you understand your insurance coverage with our office and explain all the insurance details to you. She can also advise you on the best plan if you are looking to change your coverage or help you if you need to contact your insurance provider.

We would be happy to give you an estimate for what your out-of-pocket cost will be once we have seen you for a consultation and know your exact treatment plan. Whether you are using insurance or pay for your surgery on your own, the surgery fee includes all surgery related charges at our office. Surgeon’s fee, facility fee, anesthesia fee, pre-and post-operative visit and garments are all included, and your only other additional costs would be prescriptions and laboratory fees, which may be covered by insurance depending on your insurance plan.

In most cases yes, however there are some insurance plans that do not cover revision and our insurance coordinator can assist with finding out if your policy would cover a revision surgery with our office.

If you have prescription coverage with your insurance plan, your medication should be covered under that plan. Please provide your insurance card to the pharmacist when you take in your prescription.

We have not found any insurance plan that covers scar treatments. If you had surgery with our office, Dr. Mangubat generally does not charge for post-operative scar care like steroid injections for Keloid scarring or if scar cream if needed. For more involved scar revision surgery there may be a charge, but those are rarely needed.

Please reach out to our office and our insurance coordinator will help answer all the questions you may have. In most cases you do not have to call your insurance on your own, we can do that for you. However, there are a few insurance companies that are not too forthcoming with information if we are out-of-network, and our insurance coordinator may instruct you to call your insurance provider directly and she will give you guidance and let you know what to ask.

We would be happy to help you get started. Please email us a picture of the front and back of your insurance card and your date of birth, and our insurance coordinator will get back with you within a couple of days to outline the coverage you have with our office and explain the process.

If you have multiple insurance plans and are planning to undergo gender affirming surgery, there are a few things you need to keep in mind to ensure that you maximize your insurance benefits.

Your insurance companies generally will work together to pay for your medical expenses. Coverage can vary greatly, depending on your policy and whether we are in network or out of network with your insurance. Please call our office and our insurance coordinator can help you determine which insurance plan should be billed first, based on the rules of coordination of benefits. She will also explain the process with our office based on your insurance plans.

It’s important to note that even with coordination of benefits, you may still have out-of-pocket expenses. This could be in the form of copayments, deductibles, or coinsurance.

If you have any questions or concerns about your insurance coverage for gender affirming surgery, don’t hesitate to reach out to our office and we will connect you with our insurance coordinator. She can help you navigate the complexities of insurance coverage, and work with your insurance companies to ensure that you receive the maximum benefits available to you.

It is important to contact our office immediately and provide a copy of the front and back of your new insurance card. Our insurance coordinator will check into your new coverage to determine the preauthorization requirements and submit a request for approval from your new insurance. If you are now covered under a second plan, it is also important to submit a copy of the card as well, our insurance coordinator can help to determine which plan is primary and if a preauthorization will be needed.