Gender Affirmation
Care Letters
I offer letter-writing services for the transgender & gender diverse community in the state of California.
This service can be a standalone service or part of your care throughout your time as a patient.
Assessment and letters provided in one 45-90 minute session.
$100 fee for this assessment. Reduced fee is available if standard fee is a barrier.
More details
Unfortunately, insurance coverage of gender affirming care requires specific documentation. During our assessment, I will ask some questions that the insurance company requires so that the letter can be written to meet insurance requirements.
The document will be typed up at the end of the assessment, and a copy can be send to you via an encrypted, HIPAA-compliant email immediately with my e-signature. If a “wet signature” is required, this physical copy with my signature in ink can be mailed to you within 24 Business Hours.
I follow the guidelines of the World Professional Association for Transgender Health, called Standards of Care Version 8 (SOCv8).
The Assessment
The assessment will occur via telehealth utilizes trauma informed approach and anti-oppressive questions to allow me to gather to information required by insurance. I will guide you through an informed consent process before working with you to gather the necessary information. My process doesn't require you to "prove" yourself or your identity to me, because I believe you are the expert in your own experience and identity.
Insurance requirements
Please be aware some insurance companies/plan have additional requirements, outside the published standard of care. I recommend verifying letter requirements with your specific insurance plan.
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All health plans require letters for revisions if the original letters are more than 1 year old
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Blue Cross Blue Shield (all subsidiaries): prefer letters to be from doctorate level providers. I am not a doctorate level provider.
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Anthem BCBS: 2 letters from mental health providers for "top" and "bottom" surgery dated within 6 months
Letter Format and Information Included
Letter will be on official letterhead, dated, and signed with a wet signature or verified electronic signature.
ALL letters will contain the following:
Patient Identification
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Patient’s legal name (as listed on insurance), preferred name (if different), and date of birth.
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Patient’s date of birth must be listed.
Gender Dysphoria Diagnosis Statement
The letter must confirm persistent, well-documented gender dysphoria and include all of the following:
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Desire to live and be accepted as the affirmed gender
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Identity present for at least two years
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Not a symptom of another mental health disorder
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Causes clinically significant distress or impairment
All four qualifiers must be present.
Capacity
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Statement confirming capacity for informed consent.
Letters may also contain the following, based on your individual/ insurance requirements:
Procedure Details
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Letter will clearly state the specific procedure(s) requested (e.g., phalloplasty, vaginoplasty, metoidioplasty, chest masculinization, breast augmentation, orchiectomy).
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Bundled sub-procedures do not need to be listed.
Provider Relationship
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Date the provider-patient relationship began.
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Confirmation that the patient has been seen at least once within the past 12 months (telehealth or in person).
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If only one visit has occurred, the date will be listed, or the patient must be identified as a “new patient.”
Transition History
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Confirmation of at least 12 continuous months living in a gender role congruent with gender identity.
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Confirmation of at least 12 continuous months of hormone therapy
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(Required for "bottom" surgery and breast augmentation only.)
Compliance
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Statement confirming ability to comply with long-term follow-up and post-operative expectations.
Medical & Behavioral Stability
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Statement that any significant medical or mental health conditions are reasonably well controlled.
Provider Experience
Statement describing the provider’s experience treating patients with gender dysphoria.
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