Insurance

Regrettably, healthcare in the United States is unreasonably expensive. Paying for just the vaginoplasty operation itself out of pocket is more than many individuals can financially afford. The right insurance can drastically reduce the cost the patient is responsible for covering

When I began my journey toward surgery, I switched from my W-2 job which included benefits like health insurance to being a 1099 independent contractor which did not include any benefits. Since my employer-based health insurance was slated to end, I had to find a good solution. Here are the options I entertained for myself. 

• Return to W-2 work so I could qualify for benefits
  • Starbucks and Target reliably have had excellent health insurance with robust transgender care benefits
  • Be sure to get a sample copy of the Statement of Benefits prior to accepting any job to understand the company’s health insurance policies around transgender healthcare
• Purchase insurance independently from the Marketplace
  • Plans tend to be extremely expensive and offer very limited coverage
• Qualify for Medicaid
  • Colorado Medicaid entirely covers surgery and post-operative visits with no deductible or copay
  • Unfortunately, Medicaid does not cover hair removal for surgery

I knew I wanted to avoid purchasing my own insurance from the Marketplace because of its high prices and poor coverage. In my life at the time, I was very content working as an independent contractor and I also qualified for Colorado Medicaid. I decided I would use Medicaid instead of seeking out an employer who offered health insurance.

I found that Medicaid would cover 100% of the cost of surgery and post-operative visits. Regrettably, however, it would not cover the hair removal required by my prospective surgeons for my preferred surgery. I chose to pay for laser hair removal and electrolysis entirely out of pocket.

Choosing a Surgeon

At the time I began my research in late 2022, I discovered that there were two major institutions who offered vaginoplasty: Denver Health and UC Health. I discovered that both hospitals operated by getting on a waitlist. Since I didn’t know which hospital I preferred, I joined both waitlists. 

First Impressions with UC Health

When I began working with UC Health in 2023, I personally found UC Health’s communication to be slow, difficult to decipher, and standoffish. I didn’t feel like I had access to people who could answer the laundry list of questions bubbling inside me. In my personal circles, I gathered that internally, the hospital had difficulty reserving operating rooms to conduct gender-affirming surgeries. I also heard mixed reviews of their surgeon, some swearing by them and others distinctly less than satisfied. Because of all the issues I found just by scratching the surface, I didn’t feel confident in the team at UC Health and decided to only move forward with them as a backup plan – if that.

Joining the UC Health Waitlist

I followed instructions on their website which led me to send an email to their transgender care team. Over email, we scheduled time for a brief phone call. I provided my sensitive information. Not long after, I got confirmation that I had successfully joined the waitlist. 

I asked a number of followup questions about hair removal and the length of their waitlist. In November 2022, the waitlist was 1-2 years long to get a consultation. I didn’t hear from UC health again until early October 2023 when I was offered a consultation in mid-March 2024. I turned down the offer since by this time I already had a surgery date with Denver Health.

First Impressions with Denver Health

Denver Health offers a very well-rounded transgender care experience that appears to run like a well-oiled machine. While the process leading up to surgery took a full year, I never felt stuck or at a road block I couldn’t cross. There were always contacts I could get timely and complete answers from. Because of their focus on thoroughly informing patients, I felt easy to place my confidence in Denver Health’s team. I ended up getting my surgery with Denver Health.

Surgical Interest Form

I began with Denver Health’s Surgical Interest Form where I provided my basic identifying information along with the surgery I was interested in pursuing. After submitting the form, I received regular email invitations to their monthly zoom information sessions. 

Information Session

As a prospective patient, I was required to attend at least one information session, but I found them so helpful I went multiple times. The sessions occurred on Zoom like clockwork every month and were free to attend. Each session included an informational presentation that covered the essential details of surgery preparation and recovery, a live Q&A with representatives from across the transgender care team, and an optional narrated time lapse video of the surgery itself being performed on a patient. If a question couldn’t be answered live, the panel would track down an answer after the session and deliver the answer via email. During my very first information session, a post-op vaginoplasty patient joined the Q&A panel to provide advice from their perspective as a patient.

Hair Removal

To schedule the pre-operative consultation appointment, Denver Health requires 70% of hair at the surgical site to be permanently removed. After about 4 months of monthly laser hair removal sessions and weekly 1-hour electrolysis appointments, my hair removal specialists confirmed that I had reached the 70% reduction milestone. I informed Denver Health I was ready for the next steps. 

I continued my hair removal regimen up until two weeks before surgery. By the end, I was left with only extremely thin blonde hairs my electrologist struggled to treat and were later cauterized by my surgeon during the operation.

Letters of Medical Necessity 

Denver Health instructed me it was time to collect and submit Letters of Medical Necessity. To meet my insurance requirements, I needed a total of two letters written by mental and medical health professionals. 

Scheduling Pre-operative and Surgical Appointments

Once my letters were approved, I was scheduled for a preoperative visit six months later. At the pre-operative appointment, my surgery was scheduled for late October 2023, approximately three months from the pro-operative appointment. As of November 2022, wait times between the pre-operative appointment and surgical appointment ranged from 3-7 months.