Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Post Surgery Recovery. 2020; 8:e2618. 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. Feminizing surgery - Mayo Clinic Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. J Gen Intern Med. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. A total of 36 patients (90.0%) have been approved by insurance. 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.). 2010; 19:10191024. 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. Error bars denote standard error. P < 0.05 was considered significant. 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. . In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. If performed all at once, FFS usually takes between 4- 8 hours. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Average months spent from initial facial feminization consultation to final insurance authorization decision. Estimated costs of obtaining insurance approval for FFS (B). In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. 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. Do you have access to out-of-network providers or in-network only. Do you have out of network benefits, or are you limited to providers in the network? The doctor said very encouraging. 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. According to the Philadelphia Center for Transgender Surgery,. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. 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. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Using Insurance for Facial Gender Confirming Surgery or "FFS" Care Credit approval amounts can vary from person to person. Read more on our Insurance and Finance page. FFS is a cost-effective intervention that needs to be covered by insurance policies. 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). You should be able to have easy access to this document through your insurance provider. 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. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Cost of Facial Feminization Surgery (FFS) and Insurance Information The administrator hourly compensation set at our institution was used for the cost analysis. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Capitn L, Simon D, Kaye K, et al. 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). Facial Feminization Surgery Timeline - Gender Confirmation Insurance For Facial Feminization Surgery | Allure Esthetic Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Find Dental Health Services: Department of Health - Rhode Island Facial Feminization in Korea - Everything You Need to Know! 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. (link is external) for CGSP. 2003; 349:768775. Dr. Thomas Satterwhite It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. However, this is starting to change. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Facial Feminization Surgery (FFS) | Gender Affirming Health Program 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. 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. However, this has been a persuasive strategy in some cases. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Hoang H, Bertrand AA, Hu AC, et al. Rhinoplasty. KP FFS Surgeons. Every state is different so start with Google and reach out to these services in your state, theyre here for you! 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. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. This is their communication with the insurance company verifying that the procedure is covered. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System Requested CPT codes are detailed in Supplemental Digital Content 1. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. 2016; 31:394401. I am working from the perspective that you are unable to pay in full and be reimbursed. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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. 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. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. Facial Feminization Surgery (FFS) - University of Utah Two letters from mental health providers. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. $8995. 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. 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). Facial Feminization Surgery NYC | Board Certified Plastic Surgeon 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. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Physician wages across specialties: informing the physician reimbursement debate. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. 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 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. 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. 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). Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Facial Feminization Surgery FFS Insurance Coverage Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. 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. Dr. Freet accepts both insurance and Medicare. Does Medicare cover gender reassignment surgery? - Medical News Today Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. A letter from your primary care provider or whoever prescribes your hormones. *. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 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. Upon denial, an IMR is requested directly from the insurance plan. School-Based Dental Sealants; Licensed Rhode Island Dentists. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Your scars may take up to a year to heal. All rights reserved. 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. 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 . Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 1. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. We can't guarantee insurance coverage but we can guarantee to try our hardest! Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Gender-Affirming Surgery: Original Article. An estimated 90% of all patient consults were approved for FFS under insurance. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Best FFS Surgeons: What to Know and Where to Go Facialteam Facial feminization surgery - Doctors & Departments - Mayo Clinic You will be asked to complete an intake questionnaire before your consultation. Plastic surgery on the face. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 8. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Thus, coverage significantly increases accessibility. 2). 3. 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. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 2018; 153:609616. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. 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 total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). 2018. Denver Health to Offer Facial Feminization Gender Confirmation Surgery 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. 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. Submission and review of physician-initiated appeal (1 month); 3. 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. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. https://links.lww.com/PRSGO/B648.) Facial feminization surgery: the forehead. 2014; 134:609619. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Additionally, planning and recovering from any trans surgery is hard! Bariatric Surgery. 2). The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine The generalizability of the findings presented here is limited by state laws. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Surgical techniques and analysis of results. 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. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 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. Submission and review of IMR (1 month). 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. If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna He has been performing gender surgery since 2005. Padula WV, Heru S, Campbell JD. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. 2010; 170:17281734. 10. Canner JK, Harfouch O, Kodadek LM, et al. 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. Please first read this resource for a general overview of insurance utilization for trans surgery. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. your express consent. 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. Facial Feminization Surgery (FFS) | University of Miami Health System Plast Reconstr Surg. If they are a member of WPATH or other applicable professional associations, they should name that. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. 1. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis.
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