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Frequently asked questions for getting a letter of recommendation for HRT, GRS / SRS, and top surgery with Michele O’Mara, PhD

A referral letter, also called a letter of referral, is typically required by surgeons who perform gender reassignment surgery (GRS), hormone replacement surgery (HRT), and chest surgery. In the case of gender affirmation surgery, also known as SRS, two letters from a mental health professional are typically required.

How long does the assessment and referral process take?

The quick answer is, typically the process takes one to four session(s).  A combination of variables affect how quickly this process goes. If you would like to get a reliable estimate of how many sessions you will need to get a letter of referral for a first letter of referral for GRS / SRS, a second recommendation for GRS, chest surgery, or hormone replacement therapy (HRT), you can complete this form here.

What is involved in getting a referral from you for gender reassignment surgery?

letter of recommendation, referral, GRS, Chest Surgery, HRT, SRSFirst you will need to register on my HIPPA approved, confidential client portal at www.omaratime.com and secure a time for us to meet on my online scheduler which is also in this portal.

You will be asked to complete a autobiographical review and a sexual history with me. This involves completing two separate forms on my website, and then we review your responses together in session, whether that is in-office, or online (via Skype, FaceTime, or my HIPPA approved client portal). The process is designed to effeciently gather the history and development of your gender from birth until present.

All of my forms are available online and do not need to be printed.  Once you register with me for a session, let me know, and I will mark your account “gender related,” on my end, and these forms will be accessible to you.

Once this is completed, we will review what are called “readiness factors,” as outlined in the Standards of Care.  The Standards of Care are the guidelines set forth for professionals who work with transgender folks. Readiness factors are the variables that help determine your ability to succeed with the next step of your process.  For example, to be “ready” to begin HRT, you must have the means (insurance coverage or income) to afford the hormones and the associated doctor’s visits.

It is rare that someone comes to me for a letter of referral are able to receive one.  My goal is to determine in advance if there are any concerns that will prevent you from getting this letter.

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What is the difference between a first letter of recommendation for GRS and a second letter?

Typically, the first letter of recommendation is completed by the therapist that has worked with you the longest and knows you the best.  This is usually the same therapist who referred you for hormone replacement therapy (if applicable).  The first letter tends to be more thorough, and the second letter is an endorsement for the original assessment and letter of referral. Many surgeons require a letter from both a master’s level therapist as well as a PhD level clinician.  I am typically able to write a letter to satisfy either requirements.

Do you write letters of recommendation for youth?

Generally I do not provide assessment and referrals for anyone under 18.
Yes.  I do quite a bit of work online.  Some states, however, have strict limitations for out-of-state counselors providing services to their residents without being licensed in that state.  It is always an option for me to provide online services to Indiana residents, as this is where I am licensed to practice.  For information about your state’s laws, you can view this document.

Have you written a letter of recommendation before?

Yes.  I have written several hundred letters of recommendations for multiple gender-related procedures such as chest surgery, hormone replacement therapy (HRT) and gender reassignment surgery (GRS) also known as SRS or vaginoplasty.

I have written numerous letters of referral (all accepted) to the following gender reassignment surgeons (this list does not include retired surgeons to whom I have referred over the years):

I have referred to these surgeons for chest surgery:

As for hormone replacement therapy, I refer several folks per month to local providers, as well as MD’s and endocrinologists in other states where I provide online counseling.

What are the costs for sessions?

A 50 minute session is $130.

Do you accept insurance?

I have chosen to be out-of-network for all insurance panels.  What this means is, your benefit coverage for my services will be based on your out-of-network rates.  I request full payment at the time of the session and receipts can be printed from the client portal to submit for reimbursement from your insurance company.
The actual amount of reimbursement you receive depends on your out-of-network benefits. To find out your exact level of benefits, contact the customer care # on your insurance card and request the following information:
  1. What are my out-of-network mental health benefits?
  2. What is my out-of-network deductible?
  3. How many sessions am I allowed per year?
  4. Where do I send claims for reimbursement?
  5. What is the typical length of turn-around time it takes you to reimburse a claim?

I do offer the use of MC/Visa to offset the delay between payment and reimbursement.

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