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2018; 319:691697. Plast Reconstr Surg. The analysis was done by identifying individual steps involved in the insurance process (Fig. San Francisco, CA 94108. 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. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. A letter from your primary care provider or whoever prescribes your hormones. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Do you have out of network benefits, or are you limited to providers in the network? Some of the procedures included in facial feminization surgery are: 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]. 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. Doctors and nurses take good care. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. 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. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. There are a few limitations in this study that deserve mention. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 2. 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. According to the Philadelphia Center for Transgender Surgery,. Historically, FFS hasn't been covered by health insurance or government healthcare. 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. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. School-Based Dental Sealants; Licensed Rhode Island Dentists. Are there transgender advocacy groups? Read this first. Days, whose birth name was Douglas, came out as transgender in January, 2015. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. 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. Get a bossy friend to make phone calls with you while you are dealing with the process. KP FFS Surgeons. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. 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.) Woolhandler S, Campbell T, Himmelstein DU. Available at: 9. Do you have access to out-of-network providers or in-network only. 15. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. 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. 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. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Total Staff: 34. 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. With a view to clarifying this issue and answering frequently asked questions, we have compiled the following information in an effort to not only outline how Deschamps-Braly Clinic handles finance and insurance coverage but to also provide general information about how to approach your own health insurance company regarding the cost of your facial feminization. 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 . What's your out of pocket max? 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. 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. 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. Dr. Freet accepts both insurance and Medicare. This process will be long and draining, but it is worth it. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. These delicate procedures change the male facial patterns to a softer, feminine appearance. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. James S, Herman J, Rankin S, et al. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . The objective is to soften the facial . Policy Issued By: Anthem. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Gender-Affirming Surgery: Original Article. You may be trying to access this site from a secured browser on the server. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. 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. Please enable scripts and reload this page. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 2010; 170:17281734. P < 0.05 was considered significant. Start with ensuring that you have an in-depth understanding of your insurance benefits. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. 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). Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. They accept most major insurances and work to help you get your surgery fully covered whenever possible. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Male-to-female (MTF) facial feminization. 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. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. The pre-surgical authorization process for patients in Groups B and C, constituting 60.8% of all private insurance patients in our cohort, is highly time-consuming due to the individual review periods required for each level. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. 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. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. Plast Reconstr Surg. Price (USD) Forehead Recontouring. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Additionally, planning and recovering from any trans surgery is hard! Doximity. 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.). 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? Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 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. 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. 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. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. He joined the Austin branch of the Crane Center for Transgender Surgery in 2021, where he offers Top Surgery and Breast Augmentation, Facial Feminization and Vaginoplasty. Otherwise, your deposit will be applied towards your surgical balance. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Brow Lift. Ann Plast Surg. $8995. She has the skill and artistry to help produce the aesthetic goals that transgender and non-binary patients seek with Top Surgery, Breast Augmentation and Facial Gender Confirmation Surgery. 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 Simplifying facial feminization surgery using virtual modeling on the female skull. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Braun TL, Braun JL, Hernandez C, et al. 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. 7. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. 6. 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. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 2016. *. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Tate, who has been with Starbucks for 15 years and now manages a store in Austin, Texas, is one of a growing number of Starbucks partners who have used the company's leading-edge benefits for transgender partners. Tseng P, Kaplan RS, Richman BD, et al. Co-insurance past that? This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. However, some insurers are beginning to cover FFS from select surgeons. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Every insurance company is "difficult" to work with. We can't guarantee insurance coverage but we can guarantee to try our hardest! The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Available at: 2. Group A (standard approval) included patients who were approved after undergoing a standard authorization process, such as those with Medi-Cal, Medicare, and private insurance. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Do you have a deductible to meet? 2). 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Please note that before you can schedule . Prior to meeting with the social worker, patients should complete this assessment document. 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. You should be able to have easy access to this document through your insurance provider. For more information, please refer to our Privacy Policy. Wolters Kluwer Health 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. 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. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Ask them how many FFS surgeries they perform within a year. JAMA Surg. Submission and review of IMR (1 month). The generalizability of the findings presented here is limited by state laws. 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. 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. I don't philosophically agree with this. may email you for journal alerts and information, but is committed Read more about our Clinics Finance and Insurance Policy here. Months required for definitive insurance authorization decisions for FFS. 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. The administrator hourly compensation set at our institution was used for the cost analysis. information about insurance coverage: video.transcendlegal.org 2. Until then, CCTS will continue to require all patients using insurance for . The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 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. 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. 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. If they are a member of WPATH or other applicable professional associations, they should name that. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. 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. 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. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 13. 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. Error bars denote standard error. . Post-surgery garments; Medical tests and x-rays; When choosing a board-certified plastic surgeon for facial feminization surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery. Two letters from mental health providers. An estimated 10 patients (25.0%), all with private insurance, underwent an extended approval process requiring multi-level appeals and denial overturn after IMR and frequently, state intervention.
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