From the cohort, 3 subgroups were delineated. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. 1. Please first read this resource for a general overview of insurance utilization for trans surgery. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. 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. Schedule surgery https://links.lww.com/PRSGO/B648.). 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). For more information, please refer to our Privacy Policy. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Research that Matters. 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. 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). This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Your insurance might have a requirement about length of time in care with them, or degree level. 14. 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. In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 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. Total Staff: 34. 2018. The work cannot be changed in any way or used commercially without permission from the journal. 2010; 19:10191024. 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. Until then, CCTS will continue to require all patients using insurance for . 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. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. In the rare instance that FFS Surgery is included in your health insurance policy, services may be incomplete or function only on a reimbursement basis. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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. 2016; 137:438448. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Plast Reconstr Surg Glob Open. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Wolters Kluwer Health 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. Support groups? 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. Submission and review of IMR (1 month). We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). Two letters from mental health providers. *, Time and cost of the insurance approval process for FFS. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. This is their communication with the insurance company verifying that the procedure is covered. 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. The format for an appeals process and regulations/law/policy to cite within it vary widely depending on the mix of state and local regulations that apply to your specific plan. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Choose from multiple implant types and sizes. 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. Patients were stratified into 3 groups by authorization process. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. 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. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. 1. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. Arch Intern Med. 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). With a view to clarifying this issue and answering frequently asked questions, we have compiled the following information in an effort to not only outline how Deschamps-Braly Clinic handles finance and insurance coverage but to also provide general information about how to approach your own health insurance company regarding the cost of your facial feminization. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Facial feminization surgery (FFS): The permanent . Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. 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. Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Requested CPT codes are detailed in Supplemental Digital Content 1. 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. It's an attempt to make the face as attractive as possible for as long as it lasts. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Each letter should state "this procedure is medically necessary treatment. With all letters, I advise providers to be as authoritative in their tone as possible, and to explicitly claim an expert status if appropriate. Out-of-pocket costs for FFS. 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. Available at: 9. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Justine C. Lee, MD, PhD, FACS, University of California, Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960, E-mail: [emailprotected]. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. You should be able to have easy access to this document through your insurance provider. Simplifying facial feminization surgery using virtual modeling on the female skull. 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. 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*,. 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. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. 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. 6. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . The report of the 2015 U.S. transgender survey. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Please try after some time. Please enable scripts and reload this page. 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. Ann Plast Surg. Submission and review of initial authorization request (1 month); 2. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. 2018; 153:609616. During Your FFS Procedure How long it takes: This depends on what you are having done. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Post Surgery Recovery. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 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. Dr. KathleynBrandstetter. Everyone who is able to fight through it cracks the door open a little wider for the next person. 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. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Historically, FFS hasn't been covered by health insurance or government healthcare. In fact, he is one of the most experienced gender surgeons in the world. 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. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. 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. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. https://links.lww.com/PRSGO/B648.). Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Care Credit approval amounts can vary from person to person. KP FFS Surgeons. 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. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Average months spent from initial facial feminization consultation to final insurance authorization decision. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. 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 is the term given to a collection of procedures designed to make facial features more feminine. Padula WV, Heru S, Campbell JD. Facial feminization surgery: the forehead. 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. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 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. Policy Issued By: Anthem. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Do you have access to out-of-network providers or in-network only. Descriptive statistics were performed for demographic variables. Error bars denote standard error. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. After a person pays the deductible, Medicare pays 80% of the allowable costs . Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. What's your out of pocket max? Tseng P, Kaplan RS, Richman BD, et al. 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. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Policy Title: Gender Affirming Surgery. However, this is starting to change. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. The structure of this system sucks, but it's the one in which you find yourself and it is your responsibility to make it work for you. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Location: Bangkok, Thailand. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Do you have a deductible to meet? P < 0.05 was considered significant. I always advise people to try with the insurance they have before they switch to another plan. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. 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. 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. Transgender women may choose FFS as part of their male-to-female transition process. San Francisco, CA 94108. You will be asked to complete an intake questionnaire before your consultation. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Do you have out of network benefits, or are you limited to providers in the network? He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. According to the Philadelphia Center for Transgender 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. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. As many professions say, past performance does not guarantee future results. However, the tide of change is beginning to roll in- often where Medicaid begins, private plans will be forced to follow, so the clear coverage in California and New York bodes well for everyone. 5. Your scars may take up to a year to heal.
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