This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. 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. 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. In fact, he is one of the most experienced gender surgeons in the world. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 2018; 319:691697. 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. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 2018. 14. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Support groups? This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Ask to speak to people's supervisors. Feminizing surgery - Mayo Clinic Dr. Gurjala joined Align Surgical Associates in 2019, after five years of performing gender surgery, microsurgery, and general reconstructive and aesthetic surgery in the Kaiser Permanente healthcare network. $8995. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Facial Feminization Surgery Cost - American Society of Plastic Surgeons Error bars denote standard error. Facial feminization surgery (FFS): The permanent . Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . ENQUIRE NOW. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. 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. This should be sent to you in written form, with the specific reason for the denial included. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Thus, coverage significantly increases accessibility. Read more about our Clinics Finance and Insurance Policy here. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Only if your insurance provider authorizes a Letter of Agreement. Facial Feminization Surgery: A Guide for the Transgendered Woman. How soon can I book a surgery date? 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 time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 8. 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). Transgender health care coverage | HealthCare.gov Post Surgery Recovery. 6. Please refer to theCare Credit websitefor further details. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 2015; 136:560e561e. Research that Matters. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. Submission and review of second level, patient-initiated appeal (1 month); 4. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 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. 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? Total Staff: 34. Do you have access to out-of-network providers or in-network only. Cost of Facial Feminization Surgery (FFS) and Insurance Information Please note that before you can schedule . 2016; 31:394401. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 15. 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). 3. Finding a Surgeon Integral to this whole process is the FGCS surgeon. 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. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery 2019; 144:11591168. The doctor said very encouraging. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. The blossoming of academic medical centers offering transgender surgical care also means that more well respected surgeons, with appropriate craniofacial and maxilliofacial reconstructive training, are able to do procedures through insurance. 1. 2016. Read this first. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Facial Feminization Surgery | Michigan Medicine - U of M Health 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. Available at: 2. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Paying for Transgender Surgeries - Investopedia Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Dr. Andrew Kleinberger. 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. Submission and review of IMR (1 month). Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. 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. 13. Facial Feminization Surgery FFS Insurance Coverage Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. 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. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Now you will be denied! An estimated 90% of all patient consults were approved for FFS under insurance. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. A total of 36 patients (90.0%) have been approved by insurance. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. surgical techniques and analysis of results. to maintaining your privacy and will not share your personal information without Private insurances included health maintenance organizations and preferred provider organization. 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. In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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 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]. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Both of these methods are. The report of the 2015 U.S. transgender survey. Facial feminization surgery - Doctors & Departments - Mayo Clinic 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. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. Have your facial features compromised your safety, making you a target for harassment and violence? Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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. Your insurance might have a requirement about length of time in care with them, or degree level. 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. Facial Feminization Surgery: What Is FFS, Hairline - Cleveland Clinic Hu, Allison C. BA*; Dang, Brian N. BS*; Bertrand, Anthony A. MD, MBA*; Jain, Nirbhay S. MD*; Chan, Candace H. BS*; Lee, Justine C. MD, PhD, FACS*,. 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. Physician wages across specialties: informing the physician reimbursement debate. 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%). Ousterhout DK. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. If they are a member of WPATH or other applicable professional associations, they should name that. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. 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. Plast Reconstr Surg Glob Open. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. You may be trying to access this site from a secured browser on the server. 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. Arch Intern Med. 2016; 137:438448. Your message has been successfully sent to your colleague. This is the point at which you will likely need legal support. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Dr. Javad Sajan, MD is a Cosmetic, Plastic and Reconstructive Surgeon in Seattle who specializes in Gender-Affirming Surgery including Top Surgery, Breast Augmentation, Body Sculpting and Facial Feminization. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Male-to-female (MTF) facial feminization. Upon denial, an IMR is requested directly from the insurance plan. For Bay Area trans women, facial feminization surgery helps complete During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. 6. Bariatric Surgery. 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. TransHealthCare.org uses cookies and other tracking technologies to improve your browsing experience on our website, to analyze our website traffic, and to understand where our visitors are coming from. Gray R, Nguyen K, Lee JC, et al. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. 1). Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. When it comes to facial feminization there is no substitute for experience. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Denver Health to Offer Facial Feminization Gender Confirmation Surgery 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. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. 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. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. If performed all at once, FFS usually takes between 4- 8 hours. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. 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. Read more. Braun TL, Braun JL, Hernandez C, et al. Your scars may take up to a year to heal. Capitn L, Simon D, Kaye K, et al. 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. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 2018; 80:198204. Dr. Thomas Satterwhite Insurance Requirements for Gender Confirmation Surgery - Verywell Health Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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). In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. 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. Insurance For Facial Feminization Surgery | Allure Esthetic Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Bottom Surgery: Cost, Recovery, Procedure Details, and More - Healthline His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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? FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Plast Reconstr Surg. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Generally, one provider should have a doctoral level degree (PhD, DSW, Psychiatrist MD) and the other can have a masters level degree (MSW, MHC, etc.) Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Conveniently Located to Serve Chicago and Illinois. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Dr. KathleynBrandstetter. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . 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. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. 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. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Dr. In addition, many of them don't take insurance. 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. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. See all insurance information. 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.
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