<h3>Objectives:</h3> Risk reducing surgery remains the most effective strategy to reduce the risk of ovarian cancer in women with a Hereditary Breast and Ovarian Cancer (HBOC) syndrome. Despite the substantial survival benefit, women often do not undergo risk reducing bilateral salpingo-oophorectomy (RRBSO) within the NCCN-recommended timeframes. The aim of this study was to examine factors impacting the timing and surgical uptake of RRBSO in high-risk patients receiving care at our academic urban health care system. <h3>Methods:</h3> Patients who underwent RRBSO between January 1, 2017 and September 1, 2020 at our health care system were identified using ICD codes. Demographic information collected included age, race, mutation type, personal history of cancer, family history of cancer, and type of insurance. Dates of initial gynecologic presentation, genetic testing, and surgery were recorded. Descriptive statistics were completed using SPSS 2.0 software and multiple linear regression modeling was performed to assess factors impacting timing to RRBSO. <h3>Results:</h3> One hundred sixty seven patients underwent gynecologic RRBSO during the study period. The median age of patients at time of RRBSO was 47 years (range 30-74), 134 (80.5%) identified as White, 155 (92.8%) as non-Hispanic, 159 (95.2%) spoke English as their primary language, 135 (80.8%) had private insurance. 62 (37.1%) had a <i>BRCA1</i> mutation, 69 (41.3%) a <i>BRCA2</i> mutation, and 17 (10.1%) another HBOC-related mutation. 61 (36.4%) had a personal history of cancer while 19 (11.5%) had a family history of cancer. Of the 167 patients who underwent RRBSO, 5 (2.9%) had a serous tubal intraepithelial carcinoma precursor lesion or occult invasive cancer diagnosed at time of surgery.Privately insured patients underwent RRBSO at a median age of 40 (range 28-74) whereas publicly insured patient were 46 (range 23-69) (p=0.849). The median age for genetic testing was 40 years (range 28-74) in privately insured patients and 46 years (range 23-69) in publicly insured (p=0.849). The median time from genetic testing to surgery was 51 weeks (range 3-650). On multivariate analysis, age (p<0.001) and insurance status (p=0.045) significantly impacted time from genetic testing to surgery. Patients above the age of 50 were more likely to get RRBSO in a quicker timeframe from genetic testing than patients under the age of 50 (P<0.001). <h3>Conclusions:</h3> In our cohort, publicly insured HBOC patients underwent genetic testing and RRBSO at a later median age compared to privately insured patients. While this difference was not statistically significant, it suggests a socioeconomic disparity in the age at which genetic testing and RRBSO are being completed, with RRBSOs falling outside the age recommendation of guideline-directed care. Optimizing implementation of genetic testing and RRBSO among publicly insured HBOC patients could lead to earlier identification of those at increased risk and a better opportunity to reduce the risk of cancer.