insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Facial feminization surgery - Mayo Clinic - Mayo Clinic - Mayo Clinic 6. Gray R, Nguyen K, Lee JC, et al. Submission and review of initial authorization request (1 month); 2. Doctors and nurses take good care. Descriptive statistics were performed for demographic variables. Dr. Charles Shih. 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. Facial Feminization Surgery: What You Should Know - Healthline Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Though WPATH has released the new SOC, it will take insurance companies time to evolve. 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. Requires supporting documentation that indicates specific type of FFS procedures requested. Available at: 2. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. Facial Feminization Surgery: What Is FFS, Hairline - Cleveland Clinic You will be asked to complete an intake questionnaire before your consultation. 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. 2. Facial Feminisation Surgery | Nuffield Health Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 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. 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. 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). Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. How soon can I book a surgery date? 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. Have your facial features compromised your safety, making you a target for harassment and violence? 14. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. It's an attempt to make the face as attractive as possible for as long as it lasts. 1. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Call 913-588-6200 to request a consultation. 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. 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. Gender Affirmation Surgery - University of Utah Submission and review of second level, patient-initiated appeal (1 month); 4. 3. Received for publication February 2, 2021; accepted February 27, 2021. Facial Feminization Surgery - Costs - What does FFS cost? - 2pass Clinic 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. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Are there transgender advocacy groups? Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Requested CPT codes are detailed in Supplemental Digital Content 1. Capitn L, Simon D, Kaye K, et al. Braun TL, Braun JL, Hernandez C, et al. 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. Co-insurance past that? You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Ultimately this letter is between you and your provider, but here is some sample language that has been helpful to patients I've worked with: "Patient X has been adherent to two years of hormone replacement therapy including (specific estrogen regimen.) Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System 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. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 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. We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. Ousterhout DK. Starbucks offers expanded benefits for trans people Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Some error has occurred while processing your request. As an example, the typical timeline for our Group B and C patients is as follows: 1. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery Dr. KathleynBrandstetter. 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. Want to use our data? If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. 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. Facial Feminization Surgery (FFS) Preparation Guide. See all insurance information. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 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. Does Medicare Cover Facial Feminization Surgery? This could be a good time to join (or form!) These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. This is the point at which you will likely need legal support. 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 . Any reimbursement from the insurance company (if any) would be paid directly to the patient. 3). Every insurance company is "difficult" to work with. Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery While facial feminization surgery has many potential benefits, the decision to proceed . Facial Feminization Miami | The Maercks Institute Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . 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. 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. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). He has been performing gender surgery since 2005. Plast Reconstr Surg Glob Open. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. . These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 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. For example, there are now many hospitals across the . Months required for definitive insurance authorization decisions for FFS. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. 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). 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). Our team will help you set up a MyChart account where you will have the ability to fill this out online. The blossoming of academic medical centers offering transgender surgical care also means that more well respected surgeons, with appropriate craniofacial and maxilliofacial reconstructive training, are able to do procedures through insurance. Average months spent from initial facial feminization consultation to final insurance authorization decision. Letters - Crane Center for Transgender Surgery Rhinoplasty. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Dr. Facque joined the Gender Confirmation Centers team in September 2020 as a full-time Associate Surgeon specializing in Facial Gender Confirmation Surgery, Top Surgery and Body Contouring. https://links.lww.com/PRSGO/B648.). In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. In addition to administrative time, multi-level appeals required time from the attending craniofacial surgeon for peer-to-peer reviews, writing appeal letters, and patient counseling over the 6-month period, in total averaging 3.6 0.5 hours per patient. KP FFS Surgeons. Do you have access to out-of-network providers or in-network only. Patients were stratified into 3 groups by authorization process. 8. Insurance For Facial Feminization Surgery | Allure Esthetic 12. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender 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. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Facial Feminization Surgery: A Guide for the Transgendered Woman. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Out-of-pocket costs for FFS. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 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. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. surgical techniques and analysis of results. This process will be long and draining, but it is worth it. 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. Male-to-female (MTF) facial feminization. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 2018; 80:198204. Gender-Affirming Surgery Information - East Bay We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 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. ENQUIRE NOW. Bariatric Surgery. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. 1). The administrator hourly compensation set at our institution was used for the cost analysis. information about insurance coverage: video.transcendlegal.org 2. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Post Surgery Recovery. Error bars denote standard error. Submission and review of IMR (1 month). 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. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. 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. You should be able to have easy access to this document through your insurance provider. This is also the point at which general 201 level guidance ceases to be useful. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Please enable scripts and reload this page. Care Credit approval amounts can vary from person to person. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. Privacy Policy (Updated December 15, 2022). 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. The Ins & Outs of Traveling Abroad for FFS Surgery 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. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Support groups? Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. I don't philosophically agree with this. This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures, including Top Surgery, Phalloplasty, Vaginoplasty and Facial Feminization Surgery. Total Staff: 34. Wolters Kluwer Health, Inc. All rights reserved. 2018; 153:609616. Research that Matters. If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. 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 . The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 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.) FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. Does Medicare cover gender reassignment surgery? - Medical News Today 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. Everyone who is able to fight through it cracks the door open a little wider for the next person. 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. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. 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. Thus, coverage significantly increases accessibility. Padula WV, Heru S, Campbell JD. 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. Bottom Surgery: Cost, Recovery, Procedure Details, and More - Healthline Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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*,. If it is substantial, they should name their years of experience working with transgender patients. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Facial Feminization Surgery (FFS) in Thailand - MyMediTravel If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. After a person pays the deductible, Medicare pays 80% of the allowable costs . $4985. 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, 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. What's your out of pocket max? Transgender women may choose FFS as part of their male-to-female transition process.