#‘ out of pocket cost for consult with dr mang chen
Phalloplasty Barriers to Access (US Edition):
So you want to get phalloplasty huh? That’s great! Let’s start the process but first, you have to have insurance. This part is mandatory to get surgery in the US. If you were to completely self-pay, the cost of one stage of phalloplasty (out of often multiple stages) would run you between $75k - $150k*. “Paying out of pocket” for phallo involves paying for medical insurance that will cover the costs of getting phallo. Depending on your insurance premiums, paying “out of pocket” can range from ~$100 to ~$1,000 per month+. No insurance? Can’t pay for insurance? No phallo.
Cool, we have insurance, so far so good. But wait, does your insurance cover trans-related healthcare coverage? Do you live in a state that allows exclusion of life-saving surgical transgender care or do you live in a state with mandatory trans healthcare coverage? Does your specific insurance plan (often through an employer if not from the state a la Medicare/Medicaid) cover transgender care? No? No phallo
Alright, so you have insurance and your plan covers phallo. Exciting, ok now let’s find a phallo surgeon. This is a highly specialized procedure and needs to be performed by a specialized surgeon. Is there a surgeon in your city? In your state? In the surrounding states? Do you have a surgeon in mind? Do they take your insurance or can they pursue specific agreements with your insurance under specific circumstances? Does your insurance require you see a specific surgeon (or one of a specific list of surgeons)? Oh dear, looks like phallo surgeon you want to see or can see doesn’t live locally, alright gotta factor in travel & lodging costs. No surgeon? No phallo.
Ok, so your insurance will cover phallo with some surgeon(s), let’s start meeting with surgeons! Or maybe you decided to pay out of pocket for consults with different surgeons (~$250/consult’). Let’s get on the waitlist! Current consult waitlist times are ranging from several months to a couple years depending on the surgeon. Timeframe doesn’t work for you? No phallo
Insurance, check, surgeon, check, consult, scheduled. Awesome! In the meantime, let’s start gathering our required paperwork (often called “Pre-Authorization” forms). This includes two (2) separately letters from mental health professionals. One of them is usually required to have a Masters or above. Because everyone has 2 therapists right? And we all know that trans-competent therapists are always super easy to find, never book, and never require money! And these therapists could never have transphobic gatekeeping standards that require a certain amount of session or a certain attitude to even be willing to write said letter. By the way, gotta make sure you meet the criteria including at least one (1) continuous year on hormones (for most insurances/situations). Also, gotta have your mental health “reasonably under control”. No letters? No phallo
Alrighty, so we have our insurance check, letters check, consults scheduled/completed. Let’s prep for surgery. Gotta make sure we meet the surgeon’s BMI limit first. Different surgeons will have different limits btw so you may not know ahead of meeting them individually. Also, if you’re doing urethral lengthening for RFF or ALT with most surgeons, you’ll need to do permanent hair removal to prevent hair from growing in your new urethra. Yes it’s medically necessary, yes your insurance may even list it as a “covered” service in their documents. But wait! Most insurances require you get a referral to a Doctor or practitioner of some kind (like a dermatologist) and very very few derma clinics do electrolysis. You’ll probably end up paying for this out of pocket. Sessions are generally 1-2 hours, once maybe twice per week for roughly 9-12 months on average @ around ~$100-$300 per session. Hopefully you can get this reimbursed by the way but likely not. Not ready for surgery for any reason? No phallo.
Doing good, hair removal underway, meeting all other phallo requirements & surgery is coming up. Gotta do our surgery planning. You won’t be able to work for 8-12 weeks so hope you can take that time off and afford it. You could possibly get short term disability leave but that’s also around ~60% of your pay AND doesn’t start immediately. Gotta make sure you have some savings in place to float you through with rent, food, other expenses. Speaking of housing, are you traveling or staying at home? If you’re traveling, expect to be there for 5 weeks total - 1 in hospital, 4 nearby the hospital. Gotta find long term accommodations in the area, get an AirBnB usually for around $2k depending on the area. Plus flights! So let’s say another $300-$600 per person (you’ll likely NEED another person for the first few weeks out of the hospital). Also you gotta pay for food one way or another. And also a way to/from appointments. Let’s add another $500 on the very low end. Maybe your insurance will reimburse you for some of this, probably not tho. Also need recovery supplies! LOTS of recovery supplies, it’s a long recovery & often needs wound care multiple times a day. So let’s say another $500. You’ll also need someone to help you out the first several weeks so factor in the cost of food & transport for a second person idk let’s say $500 on the low end. No accommodations? No recovery supplies? No phallo.
You haven’t even had surgery at this point btw. This all just needs to be done prior to surgery. Then comes the post-surgery costs. How much will you be paying for surgery? That depends HEAVILY on your insurance plan and can range from $0 to $12,000 with insurance. That’s just for surgery costs, anesthesiologists, hospital stay. A lot of this is calculated in advance btw & a lot of it has to be paid up front. Can’t afford that? No phallo.
This is for the phalloplasty (phallus creation) stage btw. You may need multiple stages (common) or surgical repairs (common) depending on your personal goals & recovery. Recovery time can range from 2 - 12 weeks depending on the surgery in question. These are spread throughout the period of a couple years if multiple surgeries are necessary.
Phalloplasty is a huge investment financially, physically and emotionally. It also requires TIME. Money & time are the biggest (but not only) barriers to phalloplasty access. Our medical system is horrendously lacking & transphobic because it actively bars trans people from necessary, life saving, competent transition care. Everything from basic coverage to consultation costs to pre-op prep/supplies to recovery needs should be freely available to all trans & non-binary people interested in phalloplasty.
