Planning Documents

Appendix C: The 9-Week Surgery Sprint Plan#

Week 1: Foundation#

Insurance and Financial#

• Call insurance to verify gender-affirming surgery coverage
• Request written policy documents for your specific procedure
• Identify in-network surgeons (if applicable)
• If self-pay, contact surgeon's office for cash pricing and payment plans
• Research grant opportunities (Point of Pride applications open November)

Medical#

• Schedule consultation with surgeon (may have waitlist—call immediately)
• Request medical records from current providers
• Schedule appointment with therapist for surgery letter (if needed)
• List all current medications and supplements

Administrative#

• Create a dedicated folder (physical or digital) for surgery documents
• Start a call log: date, time, person spoken to, reference numbers
• Request time off work (estimate 2-6 weeks depending on procedure)

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Week 2: Documentation#

Letters of Support#

• Confirm letter requirements with surgeon's office (WPATH SOC 8 criteria)
• Provide therapist with letter template and deadline
• If second letter needed, schedule with second provider
• Request letter from HRT prescriber confirming hormone history

Insurance#

• Submit prior authorization request (surgeon's office typically handles)
• Confirm authorization was submitted—get reference number
• Document expected timeline for authorization decision

Medical Clearance#

• Schedule primary care appointment for medical clearance
• Schedule any required pre-op testing (labs, EKG, imaging)
• Address any health issues that could delay surgery

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Week 3: Pre-Op Requirements#

Testing#

• Complete blood work (CBC, metabolic panel, coagulation studies)
• Complete any cardiac testing if required
• Complete COVID/infectious disease testing per facility requirements

Procedure-Specific#

Vaginoplasty/Vulvoplasty:

• Confirm hair removal status (should be 12-18 months complete—if not, discuss with surgeon)
• Order dilators and lubricant
• Schedule pelvic floor PT consultation

Phalloplasty:

• Complete Allen test for forearm donor site
• Schedule vascular studies if required
• Confirm smoking cessation (cotinine test may be required)

Top Surgery:

• Order compression garments
• Arrange drain management supplies

Administrative#

• Follow up on prior authorization status
• If denied, immediately file appeal (see Appeal Letter Template)
• Confirm surgery date and arrival time

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Week 4: Logistics#

Travel (if applicable)#

• Book flights (flexible tickets if possible)
• Book hotel or recovery housing for required duration
• Arrange ground transportation
• Research nearby pharmacies, urgent care, grocery stores

Caregiver#

• Confirm caregiver availability for full required period
• Share Caregiver Quick Reference with them
• Discuss expectations and daily responsibilities
• Ensure caregiver has transportation if driving

Home Preparation#

• Begin acquiring recovery supplies (see Shopping Lists appendix)
• Set up recovery space (bed, bedside station, bathroom accessibility)
• Stock easy-prep foods and beverages
• Download entertainment (shows, audiobooks, music)

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Week 5: Supply Acquisition#

Medical Supplies#

• Fill prescriptions in advance (pain medication, antibiotics, anti-nausea)
• Acquire wound care supplies (gauze, tape, saline)
• Purchase stool softeners (critical with opioids)
• Get thermometer for fever monitoring

Comfort Items#

• Install bidet attachment
• Set up bedding protection (mattress cover, disposable pads)
• Arrange pillows for positioning
• Prepare clothing (button-front shirts, loose pants, slip-on shoes)

Procedure-Specific Supplies#

• Dilators and lubricant (vaginoplasty)
• Compression garments (top surgery, phalloplasty)
• Drain management supplies (top surgery)
• Fleet enemas (nulloplasty)

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Week 6: Final Medical Clearance#

Appointments#

• Attend final pre-op appointment with surgeon
• Receive written pre-op and post-op instructions
• Ask any remaining questions (see Surgeon Questions appendix)
• Confirm post-op appointment schedule

Documentation#

• Collect all letters of support (originals or certified copies)
• Gather insurance authorization documentation
• Prepare ID, insurance cards, emergency contacts
• Complete any required facility paperwork

Health Optimization#

• Stop any medications as directed (blood thinners, certain supplements)
• Stop smoking/nicotine (should be 4-6 weeks minimum by now)
• Maintain good nutrition and hydration
• Get adequate sleep

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Week 7: Final Preparations#

Home#

• Complete recovery space setup
• Test all equipment (bidet, heating pad, etc.)
• Stock refrigerator and pantry
• Do laundry—ensure plenty of clean bedding and comfortable clothes
• Clean home (you won't be able to for weeks)

Administrative#

• Confirm all appointments (surgery, follow-ups)
• Reconfirm travel arrangements
• Provide emergency contacts to caregiver
• Set up medication tracking system (see Medication Tracker appendix)

Personal#

• Arrange pet care or plant watering if needed
• Set up bill auto-pay or handle upcoming bills
• Inform trusted people of surgery date and recovery expectations
• Prepare entertainment and comfort items

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Week 8: Pre-Op Week#

7 Days Before#

• Begin any required dietary modifications
• Confirm transportation to surgical facility
• Review all pre-op instructions

3-5 Days Before#

• Stop any final medications as directed
• Complete any last-minute supply purchases
• Charge all devices

1-2 Days Before#

• Follow pre-op bathing instructions (antimicrobial wash if required)
• Complete bowel prep if required
• Pack bag for hospital/surgical center
• Lay out comfortable clothes for discharge day
• Get good sleep (as much as anxiety allows)

Day Before#

• Follow fasting instructions precisely
• Remove nail polish if required
• Take any pre-op medications as directed
• Review arrival time and location
• Rest

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Week 9: Surgery Week#

Surgery Day#

• Arrive at designated time
• Bring: ID, insurance cards, completed paperwork, support person
• Wear comfortable, loose clothing
• Leave valuables at home

Hospital Stay (if applicable)#

• Follow all nursing instructions
• Report any concerns immediately
• Stay on top of pain management
• Begin mobility as directed

Discharge#

• Receive discharge instructions in writing
• Confirm follow-up appointments
• Fill any new prescriptions immediately
• Begin recovery at home or recovery housing

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Post-Surgery: First Week#

• Focus entirely on rest and healing
• Take medications on schedule (use Medication Tracker)
• Monitor for warning signs (fever, excessive bleeding, severe pain)
• Attend any required follow-up appointments
• Begin dilation schedule if applicable
• Accept help from caregiver

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Checklist Summary#

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If You Hit Obstacles#

Insurance denial: File appeal immediately. See Insurance Appeal Template. Contact Lambda Legal (866-542-8336) for guidance.

Therapist letter delayed: Explain urgency. Offer to provide template. Consider telehealth options for faster scheduling.

Medical clearance issue: Address immediately. Some conditions require specialist clearance—don't delay.

Financial shortfall: Apply to Point of Pride, contact surgeon about payment plans, explore medical credit options.

Caregiver falls through: Contact QueerCare Inc (SF/NYC), T4T Caregiving networks, or local trans community for emergency support.

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This timeline is aggressive but achievable. The key is starting every process immediately—don't wait for one step to complete before beginning the next. Parallel processing is your friend.

Adjust for your circumstances. Some people need more time; some need less. The structure matters more than the specific timeline.

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Appendix E: Document Checklist#

Identification#

• Government-issued photo ID (driver's license, passport, state ID)
• Insurance card(s) (front and back copies)
• Secondary insurance card if applicable

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Insurance Documentation#

• Prior authorization approval letter (with reference number)
• Written policy coverage for your specific procedure
• Predetermination of benefits (if obtained)
• List of covered services and any exclusions
• Out-of-pocket maximum documentation
• Appeal documentation (if applicable)

Record these numbers:

• Prior authorization #: _______________________
• Reference/case #: _______________________
• Insurance member ID: _______________________
• Group #: _______________________

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Letters of Support#

Required Letters (confirm with surgeon)#

• Mental health letter #1

  • Provider name: _______________________
  • Date obtained: _______________________
  • Meets WPATH SOC 8 criteria: Yes / No

• Mental health letter #2 (if required)

  • Provider name: _______________________
  • Date obtained: _______________________
  • Meets WPATH SOC 8 criteria: Yes / No

• HRT letter (confirming hormone history)

  • Provider name: _______________________
  • Duration documented: _______________________

Letter Content Verification#

Each letter should include:

• Patient identifying information
• Diagnosis (gender dysphoria/gender incongruence)
• Duration of professional relationship
• Statement that WPATH criteria are met
• Confirmation of persistent gender dysphoria
• Confirmation of capacity to consent
• That other mental health concerns are reasonably controlled
• Provider credentials and contact information
• Date and signature

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Medical Records#

• Complete medical history summary
• Current medication list with dosages
• Allergy list
• HRT history (start date, medications, dosages, prescriber)
• Relevant surgical history
• Primary care provider contact information

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Pre-Op Testing Results#

• Blood work (CBC, metabolic panel, coagulation studies)
• Type and screen (blood typing)
• EKG (if required)
• Chest X-ray (if required)
• COVID test results (if required)
• Additional testing per surgeon requirements: _______________________

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Surgical Documentation#

• Signed surgical consent forms
• Completed facility paperwork
• Pre-op instructions (printed/saved)
• Post-op instructions (printed/saved)
• Follow-up appointment schedule

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Financial Documentation#

• Payment confirmation or payment plan agreement
• Itemized cost estimate
• Deposit receipt (if applicable)
• Financing agreement (if using CareCredit, Prosper, etc.)
• Grant award letter (if applicable)
• HSA/FSA documentation (if using)

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Emergency Contacts#

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Travel Documents (if applicable)#

• Passport (for international surgery)
• Visa documentation (if required)
• Flight confirmations
• Hotel/housing confirmation
• Ground transportation confirmation
• Travel insurance documentation
• Surgeon's letter for flying post-op (if needed)

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Document Storage Recommendations#

Physical folder should contain:

• Original letters of support
• Insurance authorization documents
• Pre-op instructions
• This checklist

Digital backup (cloud or email to yourself):

• Scans of all letters
• Photos of insurance cards
• All confirmation numbers
• Surgeon contact information
• Emergency contacts

On your phone:

• Photos of insurance cards
• Surgeon's phone numbers
• Pharmacy phone number
• Emergency contacts
• Authorization reference numbers

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Pre-Appointment Checklist#

The day before your surgery, verify you have:

• Photo ID
• Insurance card(s)
• Authorization documentation
• All required letters of support
• Pre-op instructions reviewed
• Completed all required forms
• List of current medications
• Emergency contact information
• Phone charger
• This document folder

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Post-Surgery Documents to Collect#

Before discharge, ensure you receive:

• Discharge summary
• Post-op care instructions (written)
• Prescription list
• Follow-up appointment schedule
• Warning signs documentation
• Surgeon's contact numbers (office and emergency)
• Wound care instructions
• Activity restrictions
• Dilation schedule (if applicable)
• Return-to-work documentation (if needed)

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Keep this checklist updated as you gather documents. Check off items as you obtain them.

Continue exploring#

• Plan Your Surgery
• U.S. Insurance, Costs, and Documents
• Letters of Support
• Recovery Toolkit