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. Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). 1. 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. I always advise people to try with the insurance they have before they switch to another plan. Plast Reconstr Surg. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. For example, some may be reluctant to perform an osteotomy of the anterior table of the frontal bone for setback in an outpatient surgery center and, thus, default to a less aggressive method of frontal bone recontouring, which may be an undercorrection for certain patients. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. 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. 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. 6. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). 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. Facial Feminization Surgery (FFS) - University of Utah On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Facial Feminization Surgery Timeline - Gender Confirmation The doctor said very encouraging. Submission and review of physician-initiated appeal (1 month); 3. If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. Research that Matters. 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. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. 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. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. 2). PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Letters - Crane Center for Transgender Surgery Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. We hope our in-person consultation will answer all of your questions, provide your sense of confidence and also further your excitement of the path you are on. 2. 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. $8995. This is also the point at which general 201 level guidance ceases to be useful. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Patients were stratified into 3 groups by authorization process. Feminizing surgery - Mayo Clinic Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). 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. information about insurance coverage: video.transcendlegal.org 2. According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Among the total cohort, most patients had private insurance (n = 23, 57.5%), followed by Medi-Cal (n = 13, 32.5%), and Medicare (n = 4, 10.0%). Ask to speak to people's supervisors. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . 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. From the cohort, 3 subgroups were delineated. I am working from the perspective that you are unable to pay in full and be reimbursed. 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. Please first read this resource for a general overview of insurance utilization for trans surgery. Leigh JP, Tancredi D, Jerant A, et al. Please note that before you can schedule . How soon can I book a surgery date? 6. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. . https://links.lww.com/PRSGO/B648.) Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Prior to meeting with the social worker, patients should complete this assessment document. 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. Facial feminization surgery can be covered by health insurance in some instances. Padula WV, Heru S, Campbell JD. 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. Qual Life Res. The Ins & Outs of Traveling Abroad for FFS Surgery Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. 2. 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. Facial Feminization Surgery - Need FFS? Find the Best FFS Surgeons The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. As an example, the typical timeline for our Group B and C patients is as follows: 1. Doctors and nurses take good care. Submission and review of IMR (1 month). Data is temporarily unavailable. Some error has occurred while processing your request. Doximity. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Call 913-588-6200 to request a consultation. 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). 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. 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. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. your express consent. Find a Surgeon for Gender Affirming Surgery - TransHealthCare Ask them how many FFS surgeries they perform within a year. Do you have access to out-of-network providers or in-network only. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. When it comes to facial feminization there is no substitute for experience. Get a bossy friend to make phone calls with you while you are dealing with the process. Schedule surgery Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. 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.). Until then, CCTS will continue to require all patients using insurance for . One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Furthermore, revisions may be indicated in some patients over time. $4985. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? This is called facial feminization surgery. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. This should be sent to you in written form, with the specific reason for the denial included. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? 14. This might be the hardest part- no one should have to compromise quality, and the big names in FGCS have historically not taken insurance, though its my observation that this is rapidly changing. Facial Feminization in Korea - Everything You Need to Know! Some of the procedures included in facial feminization surgery are: Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. We can't guarantee insurance coverage but we can guarantee to try our hardest! https://links.lww.com/PRSGO/B648.). 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 Private insurances included health maintenance organizations and preferred provider organization. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Submission and review of initial authorization request (1 month); 2. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. 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. KP FFS Surgeons. Facial Feminization Surgery | Michigan Medicine - U of M Health Facial feminization surgery: the forehead. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Dr. Andrew Kleinberger. Choose from multiple implant types and sizes. 2020 Deschamps-braly clinic. 15. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. P < 0.05 was considered significant. 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. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. 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 . 13. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. J Gen Intern Med. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Starbucks offers expanded benefits for trans people These procedures may include: Tummy tuck, called abdominoplasty. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. 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. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Temporal trends in gender-affirming surgery among transgender patients in the United States. In addition, many of them don't take insurance. 3). 2). Requiring letters from therapists and physicians appeals to some hospitals, surgeons, and care providers, who may look at this system as legally defensible if necessary. 2015; 136:560e561e. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. 1. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System Gray R, Nguyen K, Lee JC, et al. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Error bars denote standard error. 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. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. In contrast to Group A, patients who required significant efforts in the form of multi-level appeals, peer-to-peer reviews, and IMRs were designated Groups B and C, depending on ultimate approval versus denial as the outcomes, respectively. 2019; 144:11591168. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Two letters from mental health providers. Gender-Affirmation Surgery | Transgender Surgery | The University of We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Everyone who is able to fight through it cracks the door open a little wider for the next person. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria.

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