For one if it is possible to schedule a consultation but not necessarily be ready for surgery right away (what I mean is that insurance requires one year on HRT for surgery but can the consultation take place before that? I know the wait times can be several months between consultation and surgery). 
Did you have to schedule a surgery date after consultation if you were going the insurance route? (Everything I see seems to sound like that even though I worry I might decide to go with a different surgeon).

No, you don't -- for one thing, it's totally reasonable to consult with more than one surgeon, and you're certainly not going to schedule more than one surgery. Here's what I wrote recently in another thread:

QuoteSurgeons have to compete for customers, just like anyone in any service business.  No matter how superior their "product" is, they have to get that message across to potential buyers. A consultation with a surgeon should be no different from an initial meeting with a real estate agent, an accountant, or a remodeling contractor: it's your opportunity to ask questions, get a feel for the person's expertise in their field, and find out if this is someone you can work with. It's up to them to satisfy you on those points and convince you that they can do the best job of meeting your needs.

It's reasonable to expect any such person to schedule a first meeting or consultation at no charge and with no obligation on the (potential) customer's part. You absolutely shouldn't feel that you're "wasting their time" if you book a consultation before you're ready to sign up for the service -- you're just being a smart consumer!

The reason I ask (specific to being an insurance-user) is in the case of consultations that cost money that it goes towards the surgery if using insurance (which makes little sense if I just want the consultation).

I tried to use insurance but there was an exclusion on trans care. The surgeon actually wanted a confirmation from the insurance that they would cover surgery before I scheduled. I was getting it done either way so I consulted and scheduled close together.

I didn't have my surgery covered by insurance. I booked my consult in February 2015 and had surgery in April 2015. There was no pressure to schedule surgery immediately following the consult, but I did in order to get the slot that I wanted. You have to put a deposit down to hold the spot, and you have to pay in full by the date of surgery (at least with my surgeon - it may be different with other doctors). I paid $100 for the consult and 10% of the total due to book surgery (so in total $945). Both the consult fee and the 10% go towards the final bill, so if I had been going through insurance I could've submitted those expenses as a claim to be reimbursed.

I wouldn't recommend doing a consult too far in advance unless you just want an opinion on your options. And if that's the case, get an opinion from one of the surgeons that do consults for free. If you know when your 1 year on HRT is up and that date has been documented with your insurance, I would book a consult with your surgeon of choice maybe 3 months or so in advance of that (depending on which surgeon you're going to, some have longer waits). I'd also try to save up whatever the fee is to book surgery so that if they have a date available that you want, you can hold the spot.

I recently e-mailed my surgeon's office with a few questions, and they assured that you can consult whenever you want. However, they also charge for a consult, so maybe those who do a free consult will feel differently. It can't hurt to e-mail or call and ask them directly.

I'm waiting to get my consult until about a month before surgery so that any changes to my chest from T can start to set in and they can get a better idea of what to do with my case (I'm a month and a week in and my chest has already started shrinking; I'm already more eligible for peri).