Male-to-female (MTF) facial feminization. Do you have out of network benefits, or are you limited to providers in the network? 1. 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. FFS is a cost-effective intervention that needs to be covered by insurance policies. Brow Lift. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Privacy Policy (Updated December 15, 2022). We can't guarantee insurance coverage but we can guarantee to try our hardest! document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Please try again soon. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Days, a 50-year-old Berkeley resident, had just returned from a month-long trip to Spain in February, where she underwent a procedure known as facial feminization surgery, or FFS. Patients were stratified into 3 groups by authorization process. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Get a bossy friend to make phone calls with you while you are dealing with the process. Notes. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. If it is substantial, they should name their years of experience working with transgender patients. Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. As stated above, all patients within this group were covered by private insurance plans that were not within the purview of the State of California and, thus, were not eligible for state intervention. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? P < 0.05 was considered significant. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Qual Life Res. Gender-Affirming Surgery: Original Article. 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. 3). All rights reserved. Additionally, the patients who exited their employer-based plans to buy health insurance on the exchange paid more for health insurance by foregoing employer contributions. While facial feminization surgery has many potential benefits, the decision to proceed . Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Estimated costs of obtaining insurance approval for FFS (B). Your message has been successfully sent to your colleague. Although your FFS may not be covered by your insurance company its definitely worth doing the research. If they are a member of WPATH or other applicable professional associations, they should name that. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. 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. 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. After a person pays the deductible, Medicare pays 80% of the allowable costs . Integral to this whole process is the FGCS surgeon. 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. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Surgical techniques and analysis of results. Dr. Freet accepts both insurance and Medicare. 2014; 134:609619. The benefits of such coverage far exceed the insignificant costs. If performed all at once, FFS usually takes between 4- 8 hours. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Available at: 9. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Plast Reconstr Surg Glob Open. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 2018 Physician Compensation Report. Among the total cohort, most patients had private insurance (n = 23, 57.5%), followed by Medi-Cal (n = 13, 32.5%), and Medicare (n = 4, 10.0%). 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. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization 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. Submission and review of physician-initiated appeal (1 month); 3. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Data is temporarily unavailable. 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. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. Dr. Ann Plast Surg. Choose from multiple implant types and sizes. Woolhandler S, Campbell T, Himmelstein DU. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Price (USD) Forehead Recontouring. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. From the cohort, 3 subgroups were delineated. A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. These delicate procedures change the male facial patterns to a softer, feminine appearance. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Second, while complications are not high in FFS, they may occur. 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. information about insurance coverage: video.transcendlegal.org 2. Arch Intern Med. 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. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . ENQUIRE NOW. Average months spent from initial facial feminization consultation to final insurance authorization decision. Everyone who is able to fight through it cracks the door open a little wider for the next person. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. A total of 36 patients (90.0%) have been approved by insurance. Otherwise, your deposit will be applied towards your surgical balance. *, Time and cost of the insurance approval process for FFS. Until then, CCTS will continue to require all patients using insurance for . 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. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Requested CPT codes are detailed in Supplemental Digital Content 1. Submission and review of second level, patient-initiated appeal (1 month); 4. 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 doctor said very encouraging. 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 addition, many of them don't take insurance. Doctors and nurses take good care. LGBT legal service projects? 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. Now you will be denied! 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Finally, you should have an idea of your local resources. 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. 2020; 8:e2618. 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. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 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. 7. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. 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. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). 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. Received for publication February 2, 2021; accepted February 27, 2021. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. See all insurance information. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Research that Matters. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Bariatric Surgery. KP FFS Surgeons. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. may email you for journal alerts and information, but is committed
Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Ainsworth TA, Spiegel JH. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. 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. Requires supporting documentation that indicates specific type of FFS procedures requested. 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. 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. No. 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 following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. 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. This is the point at which you will likely need legal support. However, some insurers are beginning to cover FFS from select surgeons. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. 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. When it comes to facial feminization there is no substitute for experience. Complete New Patient Questionnaire. 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. Want to use our data? Dr. Ellie Zara Ley, MD is an accomplished board-certified plastic surgeon who had more than 15 years of specialized training in plastic, craniofacial and micro surgery before learning the art of Gender Confirmation Surgery. Please refer to theCare Credit websitefor further details. We have a dedicated Insurance Advocacy Team that handles the entire process of insurance approval for patients; we send all your documents to your insurance providers and work with them to try and secure coverage to the fullest extent. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. 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. 13. 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 A prior authorization is not a guarantee of payment, therefore, you should have funds available to cover all fees and costs related to your surgery should your request be denied. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Days, whose birth name was Douglas, came out as transgender in January, 2015. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. These procedures may include: Tummy tuck, called abdominoplasty. 2018; 319:691697. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Location: Bangkok, Thailand. Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. You should be able to have easy access to this document through your insurance provider. The objective is to soften the facial . 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. In fact, he is one of the most experienced gender surgeons in the world. 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. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. 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. 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).
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