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. Facial Feminization Surgery (FFS) Preparation Guide. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. An estimated 10 patients (25.0%), all with private insurance, underwent an extended approval process requiring multi-level appeals and denial overturn after IMR and frequently, state intervention. 2016; 31:394401. . 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. In fact, he is one of the most experienced gender surgeons in the world. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? Tate, who has been with Starbucks for 15 years and now manages a store in Austin, Texas, is one of a growing number of Starbucks partners who have used the company's leading-edge benefits for transgender partners. Some error has occurred while processing your request. to maintaining your privacy and will not share your personal information without
2015; 136:560e561e. 3). Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Transgender women may choose FFS as part of their male-to-female transition process. For example, there are now many hospitals across the . 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. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Submission and review of IMR (1 month). As with any surgical procedure, there are risks associated with FFS. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Wolters Kluwer Health
Requested CPT codes are detailed in Supplemental Digital Content 1. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Qual Life Res. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. The benefits of such coverage far exceed the insignificant costs. 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. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Submission and review of initial authorization request (1 month); 2. Plast Reconstr Surg. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. your express consent. Facial feminization surgery: the forehead. 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). If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. A letter from your primary care provider or whoever prescribes your hormones. 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. 3. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. The analysis was done by identifying individual steps involved in the insurance process (Fig. Ask to speak to people's supervisors. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. San Francisco, CA 94108. These delicate procedures change the male facial patterns to a softer, feminine appearance. Privacy Policy (Updated December 15, 2022). The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. This is the point at which you will likely need legal support. Finally, you should have an idea of your local resources. 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. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Ann Plast Surg. *, Time and cost of the insurance approval process for FFS. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Conveniently Located to Serve Chicago and Illinois. Procedure. Complete New Patient Questionnaire. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. School-Based Dental Sealants; Licensed Rhode Island Dentists. Canner JK, Harfouch O, Kodadek LM, et al. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Finding a Surgeon Integral to this whole process is the FGCS surgeon. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. Descriptive statistics were performed for demographic variables. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Historically, FFS hasn't been covered by health insurance or government healthcare. Want to use our data? The pre-surgical authorization process for patients in Groups B and C, constituting 60.8% of all private insurance patients in our cohort, is highly time-consuming due to the individual review periods required for each level. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . surgical techniques and analysis of results. Dr. Thomas Satterwhite Every insurance company is "difficult" to work with. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 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. Dr. KathleynBrandstetter. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Received for publication February 2, 2021; accepted February 27, 2021. The structure of this system sucks, but it's the one in which you find yourself and it is your responsibility to make it work for you. https://links.lww.com/PRSGO/B647.). 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 Please read a few important elements consider when booking. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. Patients who are definitively denied (Group C) may then exit their employer-based plan and switch to a plan under California jurisdiction on the health insurance exchange. Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . 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. 5. 3). Doctors and nurses take good care. https://links.lww.com/PRSGO/B648.). Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. This means that the surgeon is either already in network with your insurance and is willing to send a prior authorization, or has an office willing to do the legwork of doing a letter of agreement with your insurance. Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. As stated above, all patients within this group were covered by private insurance plans that were not within the purview of the State of California and, thus, were not eligible for state intervention. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Submission and review of physician-initiated appeal (1 month); 3. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. 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. Dr. Thomas Satterwhite Lastly, FFS coverage also allows for inclusion of technologies, such as virtual modeling and surgical planning, which may be cost prohibitive in self-pay patients despite evidence that accuracy is improved.10,11. 2010; 19:10191024. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Everyone who is able to fight through it cracks the door open a little wider for the next person. There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. Available at: 2. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. All rights reserved. Procedures requested for facial feminization insurance authorization are detailed in Table 2. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. 6. may email you for journal alerts and information, but is committed
Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. See all insurance information. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Days, whose birth name was Douglas, came out as transgender in January, 2015. 10. The administrator hourly compensation set at our institution was used for the cost analysis. 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. 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. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. JCL is additionally supported by the US Department of Veterans Affairs under award number IK2 BX002442 and the National Institutes of Health/NIDCR R01 DE0289098. As an example, the typical timeline for our Group B and C patients is as follows: 1. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. He joined the Austin branch of the Crane Center for Transgender Surgery in 2021, where he offers Top Surgery and Breast Augmentation, Facial Feminization and Vaginoplasty. Among the 26 patients (65.0%) who underwent the standard approval process, 13 patients had Medi-Cal, 4 patients had Medicare, and 9 patients had private insurance. 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. Dr. Charles Shih. I could go on about this, but I hate to further the expectation that you must be very mentally ill in order for the "extreme" treatment of FGCS to be warranted. The report of the 2015 U.S. transgender survey. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Do you have out of network benefits, or are you limited to providers in the network? 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. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. (link is external) for CGSP. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 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. Plastic and Cosmetic Surgery. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Capitn L, Simon D, Kaye K, et al. https://links.lww.com/PRSGO/B648.) P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. You may be trying to access this site from a secured browser on the server. One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. Dr. Policy Title: Gender Affirming Surgery. Call 913-588-6200 to request a consultation. What's your out of pocket max? 2018; 80:198204. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. Body-contouring. We can't guarantee insurance coverage but we can guarantee to try our hardest! Thus, coverage significantly increases accessibility. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Group A (standard approval) included patients who were approved after undergoing a standard authorization process, such as those with Medi-Cal, Medicare, and private insurance. And some health insurance plans do cover the costs associated with facial feminization surgery procedures, so we recommend contacting your insurance provider to find out what is and is not covered under your current plan. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Hoang H, Bertrand AA, Hu AC, et al. $8995. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). Health insurance might not cover surgical procedures considered cosmetic for the cisgender population people whose gender identity matches the one they were assigned at birth even though these procedures are . Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Compared with the published literature, patients within Groups B and C are multi-fold greater than the reported standard estimates in the former study without even taking into account time and costs of post-surgical billing activities. 2). Notes. Patients seeking services from our practice are personally and fully responsible for payment of all fees and costs related to your FFS surgery and medical care. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . 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. Get a bossy friend to make phone calls with you while you are dealing with the process. Brow Lift. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. 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. The cost of the administrative and attending craniofacial surgeon effort for Groups B and C averaged approximately $900, over 20-fold more than Group A. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Please try again soon. This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. Lastly, a third subgroup of patients (Group C), all with private insurance, were denied for surgery despite multi-level appeals, peer-to-peer discussions, and IMR. These procedures may include: Tummy tuck, called abdominoplasty. Plastic surgery on the face. Dr. Andrew Kleinberger. 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. Until then, CCTS will continue to require all patients using insurance for . Policy Issued By: Anthem. I am working from the perspective that you are unable to pay in full and be reimbursed. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Co-insurance past that? Second, while complications are not high in FFS, they may occur. The format for an appeals process and regulations/law/policy to cite within it vary widely depending on the mix of state and local regulations that apply to your specific plan. 2). An estimated 90% of all patient consults were approved for FFS under insurance. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. 2. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. This process will be long and draining, but it is worth it. 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. Error bars denote standard error. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. Please first read this resource for a general overview of insurance utilization for trans surgery. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. 3. JAMA. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery.
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