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Top Surgery Insurance Checklist

This step-by-step checklist helps you navigate the insurance process for gender-affirming top surgery. Track your progress with the interactive bar below—your selections will be saved in your browser so you can return anytime.

Prefer pen and paper? Print this page or download a shareable PDF version to print and fill out by hand.

• 1. Verify Coverage
• Request your Certificate of Coverage
• Review the Exclusions and Limitations section and search for terms like “transgender,” “gender,” “sex reassignment,” or “cosmetic”
• Call your insurance and ask if CPT 19303 is covered for diagnosis F64.1
• Confirm if your surgeon is in-network
• Ask about preauthorization requirements
• Clarify deductible, coinsurance, and out-of-pocket maximum
• 2. Confirm Surgeon’s Participation
• Confirm surgeon accepts your insurance plan
• Ask who submits the insurance claim
• Confirm which CPT codes will be used
• Ask if a superbill will be provided if needed
• Ask if revisions are covered
• 3. Gather Required Documentation
• Get a diagnosis of gender dysphoria
• Obtain 1–2 support letters from mental health professionals
• Ensure letters use insurer's required wording
• Get a letter from your primary care provider (if needed)
• Request a letter of medical necessity from your surgeon (if required)
• Collect additional documentation like therapist notes
• 4. Submit Preauthorization
• Surgeon’s office submits preauthorization request
• Follow up to confirm approval status
• Save approval letter and reference numbers
• 5. If Denied, Prepare Appeal
• Request a written denial letter
• Check the appeal deadline
• Work with your surgeon’s office to file an appeal
• Gather letters, medical statements, and research
• 6. After Surgery: Get Reimbursed (if out-of-network)
• Request a superbill from your surgeon
• Submit the superbill to your insurance company
• Monitor your Explanation of Benefits (EOB)
• 7. Optional: Track Your Own Costs
• Estimate total out-of-pocket expenses
• Save receipts for travel, copays, and non-covered care and input into a spreadsheet
• Look into financial assistance, HSA, or FSA options

Related:

• Top Surgery Insurance Coverage Guide: How to Get Your Gender-Affirming Surgery Covered
• Top Surgery Shopping & Packing Checklist

Last updated: 05/25/25