Although your FFS may not be covered by your insurance company its definitely worth doing the research. FHS/FFS (Facial Harmonization Surgery / Facial Feminization Surgery) Metoidioplasty/Phalloplasty Vaginoplasty/Vulvoplasty Classes cover the following material: Surgical options and techniques Surgery planning and pathway at Kaiser Post-operative care and recovery Most sessions also include a patient panel 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. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Qual Life Res. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. Until then, CCTS will continue to require all patients using insurance for . Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Please enable scripts and reload this page. 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. 1). 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. Read this first. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Facial Feminization Surgery: A Guide for the Transgendered Woman. Now you will be denied! https://links.lww.com/PRSGO/B648.) An estimated 90% of all patient consults were approved for FFS under insurance. Care Credit approval amounts can vary from person to person. J Gen Intern Med. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. 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. A total of 36 patients (90.0%) have been approved by insurance. 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. 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 lady on the phone told me the surgery usually ranges from $60-100,000 dollars. https://links.lww.com/PRSGO/B647.). 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. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. All rights reserved. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. 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. 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. 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. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Doctors and nurses take good care. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. 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. Try your local trans advocacy groups, LGBTI legal services, support group, etc. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. I am working from the perspective that you are unable to pay in full and be reimbursed. Your message has been successfully sent to your colleague. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. You will be asked to complete an intake questionnaire before your consultation. Data is temporarily unavailable. The analysis was done by identifying individual steps involved in the insurance process (Fig. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. As many professions say, past performance does not guarantee future results. However, the tide of change is beginning to roll in- often where Medicaid begins, private plans will be forced to follow, so the clear coverage in California and New York bodes well for everyone. The doctor said very encouraging. https://links.lww.com/PRSGO/B648.). 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. This could be a good time to join (or form!) 2018 Physician Compensation Report. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. Ask to speak to people's supervisors. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Some error has occurred while processing your request. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Arch Intern Med. Descriptive statistics were performed for demographic variables. 5. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Facial Feminization Surgery (FFS) is a group of facial procedures that alter the face to create more classically feminine characteristics, such as a higher brow, a more refined feminine nose, and less pronounced Adams apple. Facial Feminization Surgery (FFS) Preparation Guide. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Post Surgery Recovery. Policy Issued By: Anthem. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Male-to-female (MTF) facial feminization. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. 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. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Procedure. 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. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Schedule surgery If they are a member of WPATH or other applicable professional associations, they should name that. 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. Research that Matters. . Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. 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. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. 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. 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. P < 0.05 was considered significant. 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. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. Ousterhout DK. 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 Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Plast Reconstr Surg. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. San Francisco, CA 94108. N Engl J Med. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. 1. 4. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 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. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. This means that the surgeon is either already in network with your insurance and is willing to send a prior authorization, or has an office willing to do the legwork of doing a letter of agreement with your insurance. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 2016; 137:438448. 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. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. 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. 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 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. Submission and review of second level, patient-initiated appeal (1 month); 4. 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.). Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 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). Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Days, whose birth name was Douglas, came out as transgender in January, 2015. 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.) This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 2010; 19:10191024. Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. Leigh JP, Tancredi D, Jerant A, et al. What's your out of pocket max? Read on to find out why you might pay more or less, and whether the cost is really worth it. If performed all at once, FFS usually takes between 4- 8 hours. 2018; 319:691697. 2020 Deschamps-braly clinic. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 3. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 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. Plast Reconstr Surg Glob Open. First, one of the most significant barriers to FFS for patients is the ability to pay for surgery, which ranges from $40,000 upwards for full-face, one-stage surgery. Co-insurance past that? We have a dedicated Insurance Advocacy Team that handles the entire process of insurance approval for patients; we send all your documents to your insurance providers and work with them to try and secure coverage to the fullest extent. 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. 2016; 31:394401. However, the cost can range from $1,847 to $62,000, depending on a few key factors. 13. Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental 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. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. 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 . 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. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Do you have out of network benefits, or are you limited to providers in the network? Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Please note that before you can schedule . To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face).
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