Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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). Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. 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. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. 8. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. No. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. 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. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Patients were stratified into 3 groups by authorization process. 2. 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. 11. J Gen Intern Med. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. 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. Submission and review of physician-initiated appeal (1 month); 3. Data is temporarily unavailable. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. 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. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. They accept most major insurances and work to help you get your surgery fully covered whenever possible. I don't philosophically agree with this. Brow Lift. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. 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. What's your out of pocket max? 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. 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. 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.). We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Procedure. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. 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. Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. School-Based Dental Sealants; Licensed Rhode Island Dentists. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. The objective is to soften the facial . Los Angeles, CA: University of California, Los Angeles School of Law; 2019. The administrator hourly compensation set at our institution was used for the cost analysis. We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. 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. Choose from multiple implant types and sizes. Facial Feminization Surgery (FFS) Preparation Guide. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 13. Estimated costs of obtaining insurance approval for FFS (B). 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. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . The work cannot be changed in any way or used commercially without permission from the journal. https://links.lww.com/PRSGO/B648.) 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. 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. Gray R, Nguyen K, Lee JC, et al. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization 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). Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 4. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Read on to find out why you might pay more or less, and whether the cost is really worth it. 2003; 349:768775. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. San Francisco, CA 94108. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Ousterhout DK. There are a few limitations in this study that deserve mention. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? 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. Dr. Thomas Satterwhite Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Care Credit approval amounts can vary from person to person. When it comes to facial feminization there is no substitute for experience. 2018; 319:691697. 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 A total of 36 patients (90.0%) have been approved by insurance. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Doximity. 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. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. 2016; 31:394401. You may be trying to access this site from a secured browser on the server. 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. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Please try again soon. 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 . Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Ask them how many FFS surgeries they perform within a year. 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. Gender-Affirming Surgery: Original Article. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. 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. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. 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%). 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. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. This is the point at which you will likely need legal support. your express consent. Every insurance company is "difficult" to work with. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 10. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 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. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. We can't guarantee insurance coverage but we can guarantee to try our hardest! 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Complete New Patient Questionnaire. Two letters from mental health providers. Otherwise, your deposit will be applied towards your surgical balance. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Please refer to theCare Credit websitefor further details. 15. Temporal trends in gender-affirming surgery among transgender patients in the United States. Read this first. The United States . Received for publication February 2, 2021; accepted February 27, 2021. Ann Plast Surg. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. In addition, many of them don't take insurance. Want to use our data? 2. 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. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Available at: 9. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). https://links.lww.com/PRSGO/B648.). Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. 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 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. information about insurance coverage: video.transcendlegal.org 2. 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. Facial feminization surgery: the forehead. From the cohort, 3 subgroups were delineated. 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. Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. The report of the 2015 U.S. transgender survey. Price (USD) Forehead Recontouring. 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. Submission and review of second level, patient-initiated appeal (1 month); 4. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Please read a few important elements consider when booking. Some of the procedures included in facial feminization surgery are: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Days, a 50-year-old Berkeley resident, had just returned from a month-long trip to Spain in February, where she underwent a procedure known as facial feminization surgery, or FFS. You will be asked to complete an intake questionnaire before your consultation. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. 12. Are there transgender advocacy groups? NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Integral to this whole process is the FGCS surgeon. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. 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. 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. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 1. Co-insurance past that? 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. 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. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 2018; 153:609616. 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. 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. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 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 Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. JAMA. 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. 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. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). Out-of-pocket costs for FFS. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Months required for definitive insurance authorization decisions for FFS. Simplifying facial feminization surgery using virtual modeling on the female skull. *. During Your FFS Procedure How long it takes: This depends on what you are having done. Until then, CCTS will continue to require all patients using insurance for . Most other insurance plans do not cover FFS and consider it as cosmetic surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Dr. KathleynBrandstetter. Facial feminization surgery can be covered by health insurance in some instances. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 6. Prior to meeting with the social worker, patients should complete this assessment document. 1). A letter from your primary care provider or whoever prescribes your hormones. Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. These delicate procedures change the male facial patterns to a softer, feminine appearance. 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. Ainsworth TA, Spiegel JH. The analysis was done by identifying individual steps involved in the insurance process (Fig. Every state is different so start with Google and reach out to these services in your state, theyre here for you! 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. 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).
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