This could include either shaving down or entirely re-contouring the forehead/eyesockets/sinus area using osteotomies (cutting and repositioning bones), shaving the jaw line or a sliding genioplasty (reduction and/or re-positioning of the jaw bone), lifting the upper lip, rhinoplasty (nose job), and bringing the hair line further forward, in addition to other various soft tissue facial adjustments and reduction of the adams apple. Surgeons who practice facial gender confirming surgery often have special training in reconstructing facial features using bone grafting beyond a traditional plastic surgery residency. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. In the rare instance that FFS Surgery is included in your health insurance policy, services may be incomplete or function only on a reimbursement basis. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). I always advise people to try with the insurance they have before they switch to another plan. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. Doximity. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. This is called facial feminization surgery. 3. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 2010; 19:10191024. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Surgical techniques and analysis of results. Patients were stratified into 3 groups by authorization process. Procedure. Modeling performed by Padula and colleagues for employer-based insurance plans in Massachusetts indicated that, over the course of 5 years, coverage for transition-related services would lead to societal costs of $0.016 per month per member.3 The authors concluded that the relatively low societal cost, combined with the increase in quality-adjusted life years for transgender patients, supported coverage of transition-related services in employer-based plans. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. As with any surgical procedure, there are risks associated with FFS. James S, Herman J, Rankin S, et al. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. Plastic surgery on the face. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. This is also the point at which general 201 level guidance ceases to be useful. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Please try after some time. 2). Justine C. Lee, MD, PhD, FACS, University of California, Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960, E-mail: [emailprotected]. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Facial Reconstruction: Gender affirming facial surgery is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age; and For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. First, one of the most significant barriers to FFS for patients is the ability to pay for surgery, which ranges from $40,000 upwards for full-face, one-stage surgery. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Everyone who is able to fight through it cracks the door open a little wider for the next person. https://links.lww.com/PRSGO/B648.). Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 4. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Plast Reconstr Surg. 3). Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Additionally, the patients who exited their employer-based plans to buy health insurance on the exchange paid more for health insurance by foregoing employer contributions. Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. In contrast, FFS under insurance coverage allows for inpatient care, which may be important, particularly to surgeon decision-making as well as patients who may have other medical conditions, pain control issues, or those who travel from long distances. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). With a view to clarifying this issue and answering frequently asked questions, we have compiled the following information in an effort to not only outline how Deschamps-Braly Clinic handles finance and insurance coverage but to also provide general information about how to approach your own health insurance company regarding the cost of your facial feminization. However, this has been a persuasive strategy in some cases. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. The United States . (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. surgical techniques and analysis of results. In addition to administrative time, multi-level appeals required time from the attending craniofacial surgeon for peer-to-peer reviews, writing appeal letters, and patient counseling over the 6-month period, in total averaging 3.6 0.5 hours per patient. KP FFS Surgeons. Policy Title: Gender Affirming Surgery. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Your insurance might have a requirement about length of time in care with them, or degree level. Private insurances included health maintenance organizations and preferred provider organization. In total, the time and cost estimate of the insurance appeal process was 10.8 1.0 hours and $855.00 91.53 per patient, respectively. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Plast Reconstr Surg Glob Open. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. The administrator hourly compensation set at our institution was used for the cost analysis. This should be sent to you in written form, with the specific reason for the denial included. San Francisco, CA 94108. Second, while complications are not high in FFS, they may occur. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. They submit their own information, information about the procedure being performed, and information about you. Do you have out of network benefits, or are you limited to providers in the network? Lastly, the time consumption, costs, and difficulties to the patient were not assessed. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Every state is different so start with Google and reach out to these services in your state, theyre here for you! These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Additionally, planning and recovering from any trans surgery is hard! Some error has occurred while processing your request. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Data is temporarily unavailable. For people without local connections, the facebook group, FFS Facial Feminization Surgery / Transgender TG TS and the FFS Forums on susans.org are good places to seek community support as well. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Read this first. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Complete New Patient Questionnaire. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Both of these methods are. https://links.lww.com/PRSGO/B648.). Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. Transgender women may choose FFS as part of their male-to-female transition process. Padula WV, Heru S, Campbell JD. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. Gender-Affirming Surgery: Original Article. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. FGCS is a treatment for gender dysphoria related to the secondary sex characteristics in the face, not a treatment for anxiety caused by the experience of having gender dysphoria or being a transgender person in an unkind world. I don't philosophically agree with this. The concept and treatments were developed with transfeminine patients in mind in the 1980s, led by a San Francisco-based surgeon who devised measurements for a "normal" female appearance by surveying anthropological skeletal records. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Beginning in June 2021, Dr. Esmonde will serve as a full-time Associate Surgeon with The Meltzer Clinic offering the full spectrum of gender-affirming procedures. Dr. Charles Shih. The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. 3. However, California state law stipulates gender non-discrimination in health insurance, thus, Medi-Cal covers all procedures performed specifically for the purposes of gender affirmation. If they are a member of WPATH or other applicable professional associations, they should name that. Regardless, I recommend that you fight everything out in the preauthorization/pre service review process, and not after you have already paid and might be left holding the bill. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Among the various gender-affirming procedures, facial feminization surgery (FFS) is arguably the most commonly denied surgery, as insurance companies often deem the involved procedures as cosmetic and not medically necessary. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. J Gen Intern Med. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. A letter from your primary care provider or whoever prescribes your hormones. One of the major issues among surgeons and patients with regard to insurance coverage for FFS is the lack of understanding of the process as coverage for gender healthcare is highly variable depending on state law and plan variabilities (Table 3). In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Dr. Satterwhite is a board-certified Plastic and Craniofacial Surgeon in San Francisco who is dedicated to offering the highest level of surgical care to the transgender community. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Facial Feminization Surgery (FFS) is a group of facial procedures that alter the face to create more classically feminine characteristics, such as a higher brow, a more refined feminine nose, and less pronounced Adams apple. Want to use our data? (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. $4985. While facial feminization surgery has many potential benefits, the decision to proceed . The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. After a person pays the deductible, Medicare pays 80% of the allowable costs . 10. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 6. There are 301 level topics not covered here- going out of network to an office who will only give you CPT codes performed, getting a network exception to go to a provider with skills not available among in-network surgeons, etc. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 1. Our team will help you set up a MyChart account where you will have the ability to fill this out online. may email you for journal alerts and information, but is committed TransHealthCare.org uses cookies and other tracking technologies to improve your browsing experience on our website, to analyze our website traffic, and to understand where our visitors are coming from. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. We can't guarantee insurance coverage but we can guarantee to try our hardest! If performed all at once, FFS usually takes between 4- 8 hours. I tell everyone to plan for an initial denial- even if FGCS is covered in your plan clearly, its likely that portions of the procedure will be denied as cosmetic. Simplifying facial feminization surgery using virtual modeling on the female skull. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Until then, CCTS will continue to require all patients using insurance for . He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Read more about our Clinics Finance and Insurance Policy here. Temporal trends in gender-affirming surgery among transgender patients in the United States. Do you have access to out-of-network providers or in-network only. Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist). Dr. Thomas Satterwhite However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Months required for definitive insurance authorization decisions for FFS. Capitn L, Simon D, Kaye K, et al. From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. Post Surgery Recovery. The objective is to soften the facial . Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. 6. This is the point at which you will likely need legal support. Only if your insurance provider authorizes a Letter of Agreement. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. In the standard approval process (Group A), patients were under both public and certain private insurance plans (39% of all privately insured patients in the cohort). In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Male-to-female (MTF) facial feminization. your express consent. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. Each letter should state "this procedure is medically necessary treatment. With all letters, I advise providers to be as authoritative in their tone as possible, and to explicitly claim an expert status if appropriate. There are a few limitations in this study that deserve mention. Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. Some of the procedures included in facial feminization surgery are: Brow Lift. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Rhinoplasty. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. He has been performing gender surgery since 2005. As an example, the typical timeline for our Group B and C patients is as follows: 1. Costs of health care administration in the United States and Canada. . Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Hoang H, Bertrand AA, Hu AC, et al. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Days, whose birth name was Douglas, came out as transgender in January, 2015. . Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Gray R, Nguyen K, Lee JC, et al. 1. Call 913-588-6200 to request a consultation. The doctor said very encouraging. Each patient is different and your expectations and desired results will be discussed fully in your consultation. This guide is 201 level, geared towards those who find themselves covered with an ACA exchange plan or private insurance, as Medicaid processes are much more state specific. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. 2010; 170:17281734. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. 2018; 80:198204. 2018; 319:691697. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. Requires supporting documentation that indicates specific type of FFS procedures requested. She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Submission and review of IMR (1 month). Have your facial features compromised your safety, making you a target for harassment and violence? In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Third, full-face, one-stage FFS is a highly time-consuming surgery due to the multiple anatomical areas addressed at once (averaging 8.5 hours in the senior authors experience). The Group C authorization process, which resulted in denial of services, consumed a 9-fold higher amount of time (P < 0.001) and 26-fold higher cost (P < 0.001) when compared with Group A (Fig. During Your FFS Procedure How long it takes: This depends on what you are having done. N Engl J Med. 14. Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Physician wages across specialties: informing the physician reimbursement debate. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. $8995. All patients with public insurance (Medi-Cal or Medicare) as well as a small subset of private insurance plans were approved after initial submission of authorization request or did not require approval before surgery (Medicare) (Fig. Conveniently Located to Serve Chicago and Illinois. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Upon denial, an IMR is requested directly from the insurance plan. Dr. Facque joined the Gender Confirmation Centers team in September 2020 as a full-time Associate Surgeon specializing in Facial Gender Confirmation Surgery, Top Surgery and Body Contouring. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Privacy Policy (Updated December 15, 2022). The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. Denial overturn was either mandated by the California Department of Managed Healthcare for California-insured plans or by the respective insurance companies for self-insured, employer-based plans under the Employee Retirement Income Security Act of 1974 (ERISA). Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep.
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