https://links.lww.com/PRSGO/B647.). For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. From the cohort, 3 subgroups were delineated. 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. 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. Ask to speak to people's supervisors. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). FFS: paying and picking a surgeon. Freaking out and need advice. Descriptive statistics were performed for demographic variables. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Cost of Facial Feminization Surgery (FFS) and Insurance Information Bottom Surgery: Cost, Recovery, Procedure Details, and More - Healthline Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. The administrator hourly compensation set at our institution was used for the cost analysis. 6. Look here for licensed dentists practicing in the state. 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. ENQUIRE NOW. Facial Feminization Surgery (FFS) in Mexico - MyMediTravel 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). 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. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. 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*,. Best FFS Surgeons: What to Know and Where to Go Facialteam 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. 11. Our current work highlights the high likelihood of success in FFS coverage under insurance in California, but also details the challenges that plastic surgeons and plastic surgery practices incur for coverage to occur. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. Estimated costs of obtaining insurance approval for FFS (B). 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 . A letter from your primary care provider or whoever prescribes your hormones. Gender-Affirming Surgery: Original Article. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. 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. Get a bossy friend to make phone calls with you while you are dealing with the process. 2010; 19:10191024. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 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. Gender Affirmation Surgery - University of Utah Top facial feminization surgeons will typically undertake 2-3 facial full feminization procedures a week, this equates to at least 100 or more a year. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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. 2010; 170:17281734. 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. Facial Feminization Miami | The Maercks Institute Historically, FFS hasn't been covered by health insurance or government healthcare. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. Facial Feminization Surgery Timeline - Gender Confirmation Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Dr. Charles Shih. Requires supporting documentation that indicates specific type of FFS procedures requested. Additionally, planning and recovering from any trans surgery is hard! 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. There are a few limitations in this study that deserve mention. 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. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Simplifying facial feminization surgery using virtual modeling on the female skull. 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. You may be trying to access this site from a secured browser on the server. Facial Feminization Surgery Cost - American Society of Plastic Surgeons Starbucks offers expanded benefits for trans people Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Submission and review of physician-initiated appeal (1 month); 3. 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. Patients who are definitively denied (Group C) may then exit their employer-based plan and switch to a plan under California jurisdiction on the health insurance exchange. However, some insurers are beginning to cover FFS from select surgeons. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. This could include either shaving down or entirely re-contouring the forehead/eyesockets/sinus area using osteotomies (cutting and repositioning bones), shaving the jaw line or a sliding genioplasty (reduction and/or re-positioning of the jaw bone), lifting the upper lip, rhinoplasty (nose job), and bringing the hair line further forward, in addition to other various soft tissue facial adjustments and reduction of the adams apple. Surgeons who practice facial gender confirming surgery often have special training in reconstructing facial features using bone grafting beyond a traditional plastic surgery residency. San Francisco, CA 94108. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. 3). 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. Using Insurance for Facial Gender Confirming Surgery or "FFS" Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 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. 10. 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. Transgender women may choose FFS as part of their male-to-female transition process. 1. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Facial feminization surgery - Mayo Clinic - Mayo Clinic - Mayo Clinic However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 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. Post Surgery Recovery. Facial Feminization in Korea - Everything You Need to Know! Denver Health to Offer Facial Feminization Gender Confirmation Surgery Co-insurance past that? Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. 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. 4. P < 0.05 was considered significant. Rhinoplasty. One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. No. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Try your local trans advocacy groups, LGBTI legal services, support group, etc. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. JAMA. After a person pays the deductible, Medicare pays 80% of the allowable costs . The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive 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. Best Rated Facial Feminization Surgeon (FFS) in the World Only patients with insurance authorization decisions were included in this study (n = 40). Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. 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. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. Support groups? In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 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]. Plast Reconstr Surg. Every state is different so start with Google and reach out to these services in your state, theyre here for you! Gender-Affirmation Surgery | Transgender Surgery | The University of Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. 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. 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. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). The generalizability of the findings presented here is limited by state laws. 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. Do you have out of network benefits, or are you limited to providers in the network? 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. Facial feminization surgery: the forehead. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. 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. Private insurances included health maintenance organizations and preferred provider organization. Prior to meeting with the social worker, patients should complete this assessment document. Start with ensuring that you have an in-depth understanding of your insurance benefits. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). One of the major issues among surgeons and patients with regard to insurance coverage for FFS is the lack of understanding of the process as coverage for gender healthcare is highly variable depending on state law and plan variabilities (Table 3). FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. 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. Find a Surgeon for Gender Affirming Surgery - TransHealthCare This is called facial feminization surgery. Male-to-female (MTF) facial feminization. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 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. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Patients were stratified into 3 groups by authorization process. The objective is to soften the facial . generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Available at: 2. *, Time and cost of the insurance approval process for FFS. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. 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). This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 2016; 137:438448. Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Your message has been successfully sent to your colleague. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Physician wages across specialties: informing the physician reimbursement debate. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. 14. Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. 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. 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. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 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). 15. How to Pay for Gender-Affirming Surgery - NerdWallet Body-contouring. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. The time spent on the presurgical authorization process for Groups B and C translated to an over 20-fold increase in cost ($855.00 and $988.38, respectively) compared with Group A. Navigation of the insurance process for FFS is challenging and time-consuming; however, coverage is a reality in California provided that multi-level appeals are exhausted. Available at: 9. Data is temporarily unavailable. Feminizing surgery - Mayo Clinic Modeling performed by Padula and colleagues for employer-based insurance plans in Massachusetts indicated that, over the course of 5 years, coverage for transition-related services would lead to societal costs of $0.016 per month per member.3 The authors concluded that the relatively low societal cost, combined with the increase in quality-adjusted life years for transgender patients, supported coverage of transition-related services in employer-based plans. How Do I Pay For Facial Feminization Surgery? - drbastidas.com How NOT To Choose Your Facial Feminization Surgeon Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . The Case For Facial Feminization Surgery - BuzzFeed News 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. Please try again soon. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado Does Medicare Cover Facial Feminization Surgery? 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. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. 5. Research that Matters. We can't guarantee insurance coverage but we can guarantee to try our hardest! Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Until then, CCTS will continue to require all patients using insurance for . Days, whose birth name was Douglas, came out as transgender in January, 2015. Location: Bangkok, Thailand.
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