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 N Engl J Med. 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. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Transgender women may choose FFS as part of their male-to-female transition process. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Dr. Andrew Kleinberger. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Requested CPT codes are detailed in Supplemental Digital Content 1. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 2010; 19:10191024. Facial Feminization Surgery FFS Insurance Coverage Best Rated Facial Feminization Surgeon (FFS) in the World I am working from the perspective that you are unable to pay in full and be reimbursed. You will be asked to complete an intake questionnaire before your consultation. https://links.lww.com/PRSGO/B647.). Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Facial feminization surgery: the forehead. 5. 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. Facial Feminization Surgery (FFS) | University of Miami Health System 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. Co-insurance past that? Integral to this whole process is the FGCS surgeon. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 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. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. The cost of the administrative and attending craniofacial surgeon effort for Groups B and C averaged approximately $900, over 20-fold more than Group A. Insurance and facial feminization surgery - 2pass Clinic Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 6. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. Ousterhout DK. Find a Surgeon for Gender Affirming Surgery - TransHealthCare Choose from multiple implant types and sizes. Dr. Thomas Satterwhite Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . This should be sent to you in written form, with the specific reason for the denial included. 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. 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. See all insurance information. Plast Reconstr Surg. 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. Complete New Patient Questionnaire. San Francisco, CA 94108. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Rhinoplasty. 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. 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. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Physician wages across specialties: informing the physician reimbursement debate. The generalizability of the findings presented here is limited by state laws. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. ENQUIRE NOW. Does Medicare Cover Facial Feminization Surgery? 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. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Gender-Affirmation Surgery | Transgender Surgery | The University of Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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. 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. Please try after some time. Gender Affirmation Surgery - University of Utah Letters - Crane Center for Transgender Surgery Ask them how many FFS surgeries they perform within a year. Temporal trends in gender-affirming surgery among transgender patients in the United States. Paying for Transgender Surgeries - Investopedia Average months spent from initial facial feminization consultation to final insurance authorization decision. A surgeon who takes your insurance, hopefully in-network or willing to do the legwork of a single case agreement, with whom you are ready to move forward in planning surgery. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Wolters Kluwer Health One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Using Insurance for Facial Gender Confirming Surgery or "FFS" 2016; 137:438448. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. These delicate procedures change the male facial patterns to a softer, feminine appearance. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine . On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Dr. Thomas Satterwhite The objective is to soften the facial . 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. How Much Does Facial Feminization Surgery Cost? | RealSelf Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Upon denial, an IMR is requested directly from the insurance plan. We can't guarantee insurance coverage but we can guarantee to try our hardest! As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. 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. Facial Feminization Surgery: FFS Surgery in Thailand This is the point at which you will likely need legal support. 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.) Conveniently Located to Serve Chicago and Illinois. Every insurance company is "difficult" to work with. How NOT To Choose Your Facial Feminization Surgeon Gender Affirmation Atlanta GA | Facial Feminization Alpharetta In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. 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). 2018; 319:691697. The administrator hourly compensation set at our institution was used for the cost analysis. You may be trying to access this site from a secured browser on the server. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. 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. 3). 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. 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. Gender-Affirming Surgery: Original Article. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Dr. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. FFS: money and choosing a surgeon : r/Transgender_Surgeries Do you have access to out-of-network providers or in-network only. All rights reserved. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Insurance - International Center for Transgender Care 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%). 12. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). FFS: paying and picking a surgeon. Freaking out and need advice. 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. Call 913-588-6200 to request a 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. Have your facial features compromised your safety, making you a target for harassment and violence? 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. 2). In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Denver Health to Offer Facial Feminization Gender Confirmation Surgery Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Read more. Plastic surgery on the face. 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. 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. 15. 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. Facial Feminization Surgery (FFS) in Thailand - MyMediTravel Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY During Your FFS Procedure How long it takes: This depends on what you are having done. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 They submit their own information, information about the procedure being performed, and information about you. Plast Reconstr Surg. Do you have out of network benefits, or are you limited to providers in the network? Received for publication February 2, 2021; accepted February 27, 2021. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. It's an attempt to make the face as attractive as possible for as long as it lasts. While facial feminization surgery has many potential benefits, the decision to proceed . Male-to-female (MTF) facial feminization. However, this is starting to change. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). School-Based Dental Sealants; Licensed Rhode Island Dentists. Finally, you should have an idea of your local resources. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 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. 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. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. I always advise people to try with the insurance they have before they switch to another plan. 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). Please refer to theCare Credit websitefor further details. Facial Feminisation Surgery | Nuffield Health 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. 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. An estimated 90% of all patient consults were approved for FFS under insurance. 2018; 80:198204. Now you will be denied! 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). Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Regardless, I recommend that you fight everything out in the preauthorization/pre service review process, and not after you have already paid and might be left holding the bill. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. . 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. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Dr. Charles Shih. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Prior to meeting with the social worker, patients should complete this assessment document. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Capitn L, Simon D, Kaye K, et al. Read more on our Insurance and Finance page. As an example, the typical timeline for our Group B and C patients is as follows: 1. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Until then, CCTS will continue to require all patients using insurance for . Historically, FFS hasn't been covered by health insurance or government healthcare. 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. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. There are 301 level topics not covered here- going out of network to an office who will only give you CPT codes performed, getting a network exception to go to a provider with skills not available among in-network surgeons, etc. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Requires supporting documentation that indicates specific type of FFS procedures requested. Padula WV, Heru S, Campbell JD. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. If performed all at once, FFS usually takes between 4- 8 hours. Descriptive statistics were performed for demographic variables. 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. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 2016. 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. Estimated costs of obtaining insurance approval for FFS (B). Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Available at: 9. Out-of-pocket costs 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. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Bottom Surgery: Cost, Recovery, Procedure Details, and More - Healthline Read this first. 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. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 3. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Costs of health care administration in the United States and Canada. 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. information about insurance coverage: video.transcendlegal.org 2. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery 11. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. For Bay Area trans women, facial feminization surgery helps complete Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Thus, coverage significantly increases accessibility. 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. J Gen Intern Med. Facial Feminization Surgery: Everything You Need to Know - Verywell Health Policy Issued By: Anthem. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 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. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes.
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