You may be trying to access this site from a secured browser on the server. 6. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Using Insurance for Facial Gender Confirming Surgery or "FFS" 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. Additionally, planning and recovering from any trans surgery is hard! In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. 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). Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Gender-Affirming Surgery: Original Article. Woolhandler S, Campbell T, Himmelstein DU. 3. Facial Feminization Surgery: FFS Surgery in Thailand Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons Please try after some time. 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. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures, including Top Surgery, Phalloplasty, Vaginoplasty and Facial Feminization Surgery. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Paying for Transgender Surgeries - Investopedia A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. Transgender people report years of battles for health insurance coverage Estimated costs of obtaining insurance approval for FFS (B). Research that Matters. The Ins & Outs of Traveling Abroad for FFS Surgery 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 your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. 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. 11. 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. Facial Feminization Surgery Timeline - Gender Confirmation Submission and review of second level, patient-initiated appeal (1 month); 4. 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. Call 913-588-6200 to request a consultation. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Doctors and nurses take good care. 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. He has been performing gender surgery since 2005. This is called facial feminization surgery. In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. Though WPATH has released the new SOC, it will take insurance companies time to evolve. According to the Philadelphia Center for Transgender Surgery,. I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. Gender-Affirmation Surgery | Transgender Surgery | The University of Ask to speak to people's supervisors. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Dr. Thomas Satterwhite This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. 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. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. However, some insurers are beginning to cover FFS from select surgeons. 2019; 144:11591168. The time spent on the presurgical authorization process for Groups B and C translated to an over 20-fold increase in cost ($855.00 and $988.38, respectively) compared with Group A. Navigation of the insurance process for FFS is challenging and time-consuming; however, coverage is a reality in California provided that multi-level appeals are exhausted. Facial Feminization Surgery: What You Should Know - Healthline Have your facial features compromised your safety, making you a target for harassment and violence? He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. 1. Furthermore, revisions may be indicated in some patients over time. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. Health insurance Medical Policies - Trans Health Project 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. Dr. KathleynBrandstetter. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Any reimbursement from the insurance company (if any) would be paid directly to the patient. They accept most major insurances and work to help you get your surgery fully covered whenever possible. 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. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Facial Feminization Miami | The Maercks Institute Dr. Ellie Zara Ley, MD is an accomplished board-certified plastic surgeon who had more than 15 years of specialized training in plastic, craniofacial and micro surgery before learning the art of Gender Confirmation Surgery. Price (USD) Forehead Recontouring. The Case For Facial Feminization Surgery - BuzzFeed News Dr. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Look here for licensed dentists practicing in the state. Submission and review of initial authorization request (1 month); 2. Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. Bariatric Surgery. All rights reserved. 6. Yet, a number of studies have demonstrated that FFS is not only associated with improvement in quality of life for transfeminine patients, but also, for some patients, the most important aspect of transition.47 Although significant barriers exist, an improvement in insurance coverage for FFS has occurred over time, albeit navigation of the process is both laborious and confusing. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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. Please refer to theCare Credit websitefor further details. During Your FFS Procedure How long it takes: This depends on what you are having done. Jess Ting - Plastic and Reconstructive Surgery | Mount Sinai - New York Home Profiles Mount Sinai Doctors Video Visit Available Accepting New Patients Jess Ting, MD Plastic and Reconstructive Surgery 4.6 Star s | 32 Responses CTMS 212-870-8270 View location details Book an Appointment About Me Clinical Focus Video Education & Certifications Awards The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. 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. Rhinoplasty. 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. 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. The addition of multi-level appeals in Groups B and C increased the total time for a definitive decision (7.0 and 5.1 months, respectively) and required both surgeon and administrative time to navigate the process (10.8 and 12.0 hours, respectively). 2020 Deschamps-braly clinic. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Transgender women may choose FFS as part of their male-to-female transition process. It's hard for any person to find their voice to self-advocate when such deeply personal needs are up for debate and judgement as "cosmetic" among random insurance company reviewers. 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. 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. Brow Lift. HB2084 (2016) bans gender identity discrimination in health insurance and HB2405 (2022) bans categorical exclusions for gender-affirming care under any health plan, though the law does not . Facial Feminization Surgery (FFS) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. For patients anticipating insurance coverage for your surgery, we appreciate that you may wish to seek insurance reimbursement for the cost of some or all of your feminization procedures and have outlined some general guidelines below. Notes. 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 is the point at which you will likely need legal support. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Feminizing surgery - Mayo Clinic 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. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic When it comes to facial feminization there is no substitute for experience. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. 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. Facial feminization surgery - Doctors & Departments - Mayo Clinic Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Please enable scripts and reload this page. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa Until then, CCTS will continue to require all patients using insurance for . A prior authorization is not a guarantee of payment, therefore, you should have funds available to cover all fees and costs related to your surgery should your request be denied. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Please first read this resource for a general overview of insurance utilization for trans surgery. 2018 Physician Compensation Report. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Their credential as an MD/DO/NP/PA/MSW/PHD and signature on an essentially form WPATH conforming letter are not sufficient- they need to impress upon the medical reviewers that they are not simply approving your referral request, but are guiding your care as a treating provider, and that this surgery is part of your care plan. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Only patients with insurance authorization decisions were included in this study (n = 40). The report of the 2015 U.S. transgender survey. Facial Feminization Surgery (FFS) | Gender Affirming Health Program 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. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 4. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. A letter from your primary care provider or whoever prescribes your hormones. There are a few limitations in this study that deserve mention. Facial Feminisation Surgery | Nuffield Health Plastic surgery on the face. N Engl J Med. Months required for definitive insurance authorization decisions for FFS. Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. JAMA. to maintaining your privacy and will not share your personal information without 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. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. 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. 5. 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. Best FFS Surgeons: What to Know and Where to Go Facialteam The generalizability of the findings presented here is limited by state laws. For more information, please refer to our Privacy Policy. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. As with any surgical procedure, there are risks associated with FFS. 1. Dr. Thomas Satterwhite ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Insurance Requirements for Gender Confirmation Surgery - Verywell Health Care Credit approval amounts can vary from person to person. How soon can I book a surgery date? The doctor said very encouraging. Historically, FFS hasn't been covered by health insurance or government healthcare. How to Pay for Gender-Affirming Surgery - NerdWallet surgical techniques and analysis of results. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Are there transgender advocacy groups? Facial Feminization Surgery: A Guide for the Transgendered Woman. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. 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. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. I always advise people to try with the insurance they have before they switch to another plan. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 2. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). 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. Facial Feminization Surgery - Need FFS? Find the Best FFS Surgeons Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. Doximity. 2018. Submission and review of physician-initiated appeal (1 month); 3. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado Plast Reconstr Surg. A surgeon who takes your insurance, hopefully in-network or willing to do the legwork of a single case agreement, with whom you are ready to move forward in planning surgery. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Facial Feminization Surgery - Costs - What does FFS cost? - 2pass Clinic 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. Ask them how many FFS surgeries they perform within a year. https://links.lww.com/PRSGO/B648.). 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]. Facial Feminization Surgery (FFS) Preparation Guide. Every insurance company is "difficult" to work with. Dr. Freet accepts both insurance and Medicare. Data is temporarily unavailable. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Your insurance might have a requirement about length of time in care with them, or degree level. 1. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 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. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Private insurances included health maintenance organizations and preferred provider organization. However, this has been a persuasive strategy in some cases. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). In fact, he is one of the most experienced gender surgeons in the world. Physician wages across specialties: informing the physician reimbursement debate. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 2). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Requires supporting documentation that indicates specific type of FFS procedures requested. The United States . Post Surgery Recovery. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. 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. 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. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. What's your out of pocket max? Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. Thus, coverage significantly increases accessibility. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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. Error bars denote standard error. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Facial Feminization Surgery: Everything You Need to Know - Verywell Health Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . 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. Facial Feminization Surgery under Insurance: The University - LWW
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