The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. 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. Dr. Satterwhite is a board-certified Plastic and Craniofacial Surgeon in San Francisco who is dedicated to offering the highest level of surgical care to the transgender community. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? However, some insurers are beginning to cover FFS from select surgeons. Submission and review of initial authorization request (1 month); 2. Available at: 2. 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.). However, this has been a persuasive strategy in some cases. 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. Dr. Thomas Satterwhite https://links.lww.com/PRSGO/B647.). Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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]. It's an attempt to make the face as attractive as possible for as long as it lasts. 1. 3). Schedule surgery We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Submission and review of physician-initiated appeal (1 month); 3. Surgical techniques and analysis of results. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. This is called facial feminization surgery. 2016; 137:438448. 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. 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. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. The cost of the administrative and attending craniofacial surgeon effort for Groups B and C averaged approximately $900, over 20-fold more than Group A. 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. All rights reserved. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 3. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 2018 Physician Compensation Report. Please first read this resource for a general overview of insurance utilization for trans surgery. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. This is their communication with the insurance company verifying that the procedure is covered. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. No. 2020 Deschamps-braly clinic. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. 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 addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 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 2018; 153:609616. 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. Tseng P, Kaplan RS, Richman BD, et al. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 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). Please refer to theCare Credit websitefor further details. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine 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. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Arch Intern Med. According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. 2). Plast Reconstr Surg. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. 2018; 319:691697. 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. Only patients with insurance authorization decisions were included in this study (n = 40). 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. Plast Reconstr Surg Glob Open. Received for publication February 2, 2021; accepted February 27, 2021. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. FFS is a cost-effective intervention that needs to be covered by insurance policies. 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. 2015; 136:560e561e. If they are a member of WPATH or other applicable professional associations, they should name that. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. may email you for journal alerts and information, but is committed 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. Denial overturn was either mandated by the California Department of Managed Healthcare for California-insured plans or by the respective insurance companies for self-insured, employer-based plans under the Employee Retirement Income Security Act of 1974 (ERISA). Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Padula WV, Heru S, Campbell JD. This is the point at which you will likely need legal support. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. San Francisco, CA 94108. 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. 2). We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. Submission and review of second level, patient-initiated appeal (1 month); 4. 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. Both of these methods are. The administrator hourly compensation set at our institution was used for the cost analysis. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. https://links.lww.com/PRSGO/B648.). 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. Call 913-588-6200 to request a consultation. Error bars denote standard error. 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. Integral to this whole process is the FGCS surgeon. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. As an example, the typical timeline for our Group B and C patients is as follows: 1. Otherwise, your deposit will be applied towards your surgical balance. 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. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. 2018. There are a few limitations in this study that deserve mention. 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? 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. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. See all insurance information. Transgender women may choose FFS as part of their male-to-female transition process. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Regardless, I recommend that you fight everything out in the preauthorization/pre service review process, and not after you have already paid and might be left holding the bill. Woolhandler S, Campbell T, Himmelstein DU. Facial feminization surgery can be covered by health insurance in some instances. 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. Ousterhout DK. 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. Do you have a deductible to meet? https://links.lww.com/PRSGO/B648.). In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Canner JK, Harfouch O, Kodadek LM, et al. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. 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. Capitn L, Simon D, Kaye K, et al. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Bariatric Surgery. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. 10. This should be sent to you in written form, with the specific reason for the denial included. 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. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. 6. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 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. Descriptive statistics were performed for demographic variables. Dr. Thomas Satterwhite Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. And some health insurance plans do cover the costs associated with facial feminization surgery procedures, so we recommend contacting your insurance provider to find out what is and is not covered under your current plan. information about insurance coverage: video.transcendlegal.org 2. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 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. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. You will be asked to complete an intake questionnaire before your consultation. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Patients seeking services from our practice are personally and fully responsible for payment of all fees and costs related to your FFS surgery and medical care. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Some of the procedures included in facial feminization surgery are: Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. The doctor said very encouraging. In addition, many of them don't take insurance. Their credential as an MD/DO/NP/PA/MSW/PHD and signature on an essentially form WPATH conforming letter are not sufficient- they need to impress upon the medical reviewers that they are not simply approving your referral request, but are guiding your care as a treating provider, and that this surgery is part of your care plan. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. 1. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. 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. Some error has occurred while processing your request. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. 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. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 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). Wolters Kluwer Health 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. Hoang H, Bertrand AA, Hu AC, et al. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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.) Submission and review of IMR (1 month). J Gen Intern Med. 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. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Upon denial, an IMR is requested directly from the insurance plan. Choose from multiple implant types and sizes. 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). Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Policy Title: Gender Affirming Surgery. 2). Ann Plast Surg. 15. The benefits of such coverage far exceed the insignificant costs. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Read more on our Insurance and Finance page. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Price (USD) Forehead Recontouring. Ask them how many FFS surgeries they perform within a year. Facial Feminization Surgery (FFS) Preparation Guide. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 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. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 8. 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. 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. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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. They submit their own information, information about the procedure being performed, and information about you. 2018; 80:198204. 2020; 8:e2618. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. 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. Every insurance company is "difficult" to work with. Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. Please try again soon. Requested CPT codes are detailed in Supplemental Digital Content 1. Dr. 2003; 349:768775. Until then, CCTS will continue to require all patients using insurance for . Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. I always advise people to try with the insurance they have before they switch to another plan. 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. 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 Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Dr. Charles Shih. 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. He has been performing gender surgery since 2005. It involves plastic surgery techniques in which the jaw, chin, cheeks, forehead, nose, and areas surrounding the eyes, ears or lips are changed to create a more feminine appearance. Your insurance might have a requirement about length of time in care with them, or degree level.
My Husband Takes No Responsibility For Anything,
Andrewsky Tiktok Lawyer,
Greg Kelley Football Wife,
Articles F
