Before Your Appointment – What you need to know

UW Medicine follows the standards of care determined by the World Professional Association of Transgender Health (WPATH) and ask that you have a primary care provider referral and all required clinical documentation faxed or sent in to UW Medicine prior to scheduling or arriving to your consultation appointment.

We strive to increase access to gender affirming care and support our trans and non-binary patients; the clinical documentation requested prior to scheduling a surgical consult is required by the WPATH’s standards of care. This will help ensure your visits are valuable and moving forward with surgical approval and insurance coverage (if applicable), prior to surgery. Individual insurance plans may require more then those listed below, but a primary care provider letter will be needed prior to scheduling a consult appointment and a mental health provider letter will be needed prior to your arrival for  your consult appointment for gender affirming surgery. If we have not received these provider letters prior to your consult appointment, you will be asked to reschedule.

• Hormone Replacement Therapy (HRT) – Informed Consent, no letters needed (primary care provider and patient discussion).

• All Gender Affirming Surgeries require the following WPATH guidelines be met, and for insurance plans to approve coverage of procedures for Gender Dysphoria (this excludes post-operative repairs or emergencies):

1. 1. Letter of surgical support from a primary care provider – This is often the provider who diagnosed Gender Dysphoria, and/or prescribes and monitors HRT if present.
   2. One Letter from a licensed mental health provider affirming readiness for surgery
   3. Letter from surgeon in support of surgery and affirming readiness for surgery (This will be done after surgical consult with the surgeon)

Letter requirements and a template can be downloaded below and given to your primary care provider for guidance if unfamiliar: 

• Primary care provider letter requirements and example
• Licensed mental health provider letter requirements and example

* Mental health evaluations or qualifying psychotherapy must be performed by, and letters of recommendation written by, professionals who are state licensed to practice independently (without supervision) as master’s degree level mental health clinicians, doctoral level mental health clinicians, psychiatric nurse practitioners, psychiatric physician assistants, or Board-Eligible or Board-Certified psychiatrists.

How to schedule an appointment with the right UW Medicine provider

Please visit our gender affirming services page to find the UW Medicine services and providers you are looking for.

All gender affirming surgeries must meet the World Professional Association of Transgender Health (WPATH) standards of care and have this documented by both a primary care provider and mental health provider(s), regardless of insurance coverage and payment. All gender affirming health providers are required to follow WPATH standards of care that include provider letters, without exception.

For new patients looking for primary care: Follow the links on each provider’s page to contact their clinics and schedule an appointment. No referrals or provider letters are needed.

For patients looking for specialty care: Please contact your primary care provider (PCP) to have them fax or send a referral to the specialist provider, indicating gender affirming care and include any relevant medical notes.

For patients looking for surgical care: Please contact your primary care provider (PCP) to have them fax or send a referral to the surgeon indicating gender affirming surgery and include any relevant medical notes. Your PCP will also need to fax or send their letter of surgical endorsement, and your mental health provider(s) will also need to complete their evaluation for medical readiness letter that can be faxed in prior to your arrival for your consult appointment. If your provider is unfamiliar with writing these letters, the links above detail the letter requirements and provide a sample template.

Before Scheduling, please review the insurance plans UW Medicine accepts, the gender affirming medical policy of your insurance plan, and the World Professional Association of Transgender Health (WPATH) standards of care for more information on gender affirming care and coverage requirements.

Does UW Medicine accept my insurance?

UW Medicine has many physicians and locations that provide gender affirming care, all of which accept many commercial, Washington State, and Medicare health plans:

Depending on your insurance and health needs, a referral to specialty or surgical providers and coverage for those services may require approval from your insurance plan.

Please visit our Billing and Insurance page to check if your insurance plan is accepted at UWM. We recommend that you also call your insurance company to learn what services and providers are covered under your plan.

UWM Facilities, hours, and locations:

Harborview Medical Center
University of Washington Medical Center – Montlake
University of Washington Medical Center – Northwest 
Valley Medical Center
UW Neighborhood Clinics

Get Help Navigating Your Insurance

For questions about insurance, billing or medical records, please contact our Patient Financial Services support team, Monday through Friday, 8:00 a.m. – 4:30 p.m.

• Patient Financial Navigators: (206) 223-6715
• Authorizations: (206) 341-1870

If you are uninsured UW Medicine offers financial assistance, under its Financial Assistance policy, to eligible patients unable to pay for emergency or other medically necessary care. Patients who choose UW Medicine benefit from our experience, expertise and the most advanced medical care available, all within one health system.  Learn more about the requirements and how to apply.

Links to Gender Affirming Medical Policies

Aetna Gender Affirming Medical Policy

Alaska Medicaid Non-Covered Medicaid Services (search for gender reassignment procedures – not covered)

Anthem

Blue Cross Blue Shield of Illinois 

Blue Cross Blue Shield A Fee-For-Service Plan (FEP Blue Standard and FEP Blue Basic Options) with a Preferred Provider Organization (search for Gender reassignment – surgical benefits start on pg. 66)

Cigna

Health Care Authority Provider Billing Guide (Page 308 Transhealth Program)

• Washington Apple Health (Medicaid) Health Care Authority Transhealth benefit Overview

Kaiser Permanente Washington Gender Affirming Medical Policy

Lifewise Gender Affirming Medical Policy

Molina Healthcare Marketplace

Premera Blue Cross Commercial Gender Affirming Medical Policy

Premera Blue Cross Washington Individual Gender Affirming Medical Policy

Premera Medicare Advantage Medical Policy

Regence Blue Cross Gender Affirming Interventions for Gender Dysphoria Medical Policy

Regence Blue Cross Medicare Advantage Gender Affirming Interventions for Gender Dysphoria Medical Policy

Tricare Gender Dysphoria Medical Policy

United Healthcare Commercial Gender Dysphoria Treatment Medical Policy

United Healthcare Medicare Advantage Gender Dysphoria and Gender Reassignment Surgery Medical Policy

Financial Assistance: