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Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery Lastly, a third subgroup of patients (Group C), all with private insurance, were denied for surgery despite multi-level appeals, peer-to-peer discussions, and IMR. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. 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%). Both of these methods are. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Padula WV, Heru S, Campbell JD. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . 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). 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. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Everyone who is able to fight through it cracks the door open a little wider for the next person. Please read a few important elements consider when booking. All rights reserved. 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. Ousterhout DK. FFS is a cost-effective intervention that needs to be covered by insurance policies. KP FFS Surgeons. 2014; 134:609619. your express consent. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. The administrator hourly compensation set at our institution was used for the cost analysis. 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. For more information, please refer to our Privacy Policy. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Patients were stratified into 3 groups by authorization process. 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. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. 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. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Beginning in June 2021, Dr. Esmonde will serve as a full-time Associate Surgeon with The Meltzer Clinic offering the full spectrum of gender-affirming procedures. Dr. Andrew Kleinberger. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. He has been performing gender surgery since 2005. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. 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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Gender-Affirmation Surgery | Transgender Surgery | The University of Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. 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. James S, Herman J, Rankin S, et al. The report of the 2015 U.S. transgender survey. Facial Feminization Surgery (FFS) in Thailand - MyMediTravel 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado How Much Does Facial Feminization Surgery Cost? | RealSelf She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. Insurance For Facial Feminization Surgery | Allure Esthetic Facial Feminization Surgery: Everything You Need to Know - Verywell Health You will be asked to complete an intake questionnaire before your consultation. 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. The doctor said very encouraging. Cost of Facial Feminization Surgery (FFS) and Insurance Information 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 . These delicate procedures change the male facial patterns to a softer, feminine appearance. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Some of the procedures included in facial feminization surgery are: Facial Feminisation Surgery | Nuffield Health In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Administrative costs associated with physician billing and insurance-related activities at an academic health care system. 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. Facial Feminization Surgery NYC | Board Certified Plastic Surgeon Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. However, some insurers are beginning to cover FFS from select surgeons. $8995. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Denver Health to Offer Facial Feminization Gender Confirmation Surgery These patients underwent a standard approval process no different from other reconstructive procedures (Group A). We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. 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. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. 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). 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). 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.) In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. This could be a good time to join (or form!) 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.) As an example, the typical timeline for our Group B and C patients is as follows: 1. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? . It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. Facial Feminization Surgery (FFS) | Gender Affirming Health Program 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. 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. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Find Dental Health Services: Department of Health - Rhode Island Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. 10. Gender-Affirming Surgery Information - East Bay 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. 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. In contrast, FFS under insurance coverage allows for inpatient care, which may be important, particularly to surgeon decision-making as well as patients who may have other medical conditions, pain control issues, or those who travel from long distances. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. 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. According to the Philadelphia Center for Transgender Surgery,. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Rhinoplasty. Facial Feminization Surgery under Insurance: The University - LWW This is also the point at which general 201 level guidance ceases to be useful. However, this is starting to change. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. The Group C authorization process, which resulted in denial of services, consumed a 9-fold higher amount of time (P < 0.001) and 26-fold higher cost (P < 0.001) when compared with Group A (Fig. 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. Every insurance company is "difficult" to work with. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 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. The objective is to soften the facial . 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. Facial Feminization Surgery: FFS Surgery in Thailand Surgery referral assessment requirements | Gender Affirming Health Program We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. Months required for definitive insurance authorization decisions for FFS. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Do you have access to out-of-network providers or in-network only. 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. Transgender women may choose FFS as part of their male-to-female transition process. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. https://links.lww.com/PRSGO/B648.). In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Private insurances included health maintenance organizations and preferred provider organization. Facial Feminization Surgery: What Is FFS, Hairline - Cleveland Clinic Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 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. Dr. Freet accepts both insurance and Medicare. Facial Feminization Surgery Before & After Pictures - RealSelf Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Procedure. Please note that before you can schedule . These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. 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. 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. 14. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. may email you for journal alerts and information, but is committed 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. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. If performed all at once, FFS usually takes between 4- 8 hours. 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 . The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 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. 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. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Jess Ting - Plastic and Reconstructive Surgery | Mount Sinai - New York Home Profiles Mount Sinai Doctors Video Visit Available Accepting New Patients Jess Ting, MD Plastic and Reconstructive Surgery 4.6 Star s | 32 Responses CTMS 212-870-8270 View location details Book an Appointment About Me Clinical Focus Video Education & Certifications Awards Simplifying facial feminization surgery using virtual modeling on the female skull. Plast Reconstr Surg. 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. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Does Medicare cover gender reassignment surgery? - Medical News Today 6. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Tseng P, Kaplan RS, Richman BD, et al. Wolters Kluwer Health Some error has occurred while processing your request. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. 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*,. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Best Rated Facial Feminization Surgeon (FFS) in the World (link is external) for CGSP. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. And some health insurance plans do cover the costs associated with facial feminization surgery procedures, so we recommend contacting your insurance provider to find out what is and is not covered under your current plan. While facial feminization surgery has many potential benefits, the decision to proceed . For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Descriptive statistics were performed for demographic variables. Gender-Affirming Surgery: Original Article. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Dr. Thomas Satterwhite 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. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. This should be sent to you in written form, with the specific reason for the denial included. 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. Error bars denote standard error. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic 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. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Co-insurance past that? 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. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery Plast Reconstr Surg. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. We can't guarantee insurance coverage but we can guarantee to try our hardest!

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