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. They submit their own information, information about the procedure being performed, and information about you. Every insurance company is "difficult" to work with. 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. Costs of health care administration in the United States and Canada. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. 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. Days, whose birth name was Douglas, came out as transgender in January, 2015. 2018; 80:198204. Please read a few important elements consider when booking. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Plastic and Cosmetic Surgery. Read more on our Insurance and Finance page. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Gray R, Nguyen K, Lee JC, et al. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Your scars may take up to a year to heal. This could be a good time to join (or form!) Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. If it is substantial, they should name their years of experience working with transgender patients. 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. Plastic surgery on the face. Do you have out of network benefits, or are you limited to providers in the network? 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 is the term given to a collection of procedures designed to make facial features more feminine. 3. For example, there are now many hospitals across the . Two letters from mental health providers. This is their communication with the insurance company verifying that the procedure is covered. 2. Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Second, while complications are not high in FFS, they may occur. Every state is different so start with Google and reach out to these services in your state, theyre here for you! Submission and review of initial authorization request (1 month); 2. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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). 3). $4985. 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. Canner JK, Harfouch O, Kodadek LM, et al. Dr. KathleynBrandstetter. It's an attempt to make the face as attractive as possible for as long as it lasts. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. Do you have a deductible to meet? 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 8. Start with ensuring that you have an in-depth understanding of your insurance benefits. Descriptive statistics were performed for demographic variables. During Your FFS Procedure How long it takes: This depends on what you are having done. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Additionally, planning and recovering from any trans surgery is hard! Simplifying facial feminization surgery using virtual modeling on the female skull. 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 (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Woolhandler S, Campbell T, Himmelstein DU. 2020; 8:e2618. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. 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. . In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. There are a few limitations in this study that deserve mention. It involves plastic surgery techniques in which the jaw, chin, cheeks, forehead, nose, and areas surrounding the eyes, ears or lips are changed to create a more feminine appearance. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. 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. 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. 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 report of the 2015 U.S. transgender survey. 13. Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 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 pre-surgical authorization process for patients in Groups B and C, constituting 60.8% of all private insurance patients in our cohort, is highly time-consuming due to the individual review periods required for each level. information about insurance coverage: video.transcendlegal.org 2. 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. Conveniently Located to Serve Chicago and Illinois. Please try after some time. In fact, he is one of the most experienced gender surgeons in the world. to maintaining your privacy and will not share your personal information without 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. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . 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. Dr. Thomas Satterwhite 2). These delicate procedures change the male facial patterns to a softer, feminine appearance. Patients were stratified into 3 groups by authorization process. According to the Philadelphia Center for Transgender Surgery,. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. *, Time and cost of the insurance approval process for FFS. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 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. Facial Feminization Surgery: A Guide for the Transgendered Woman. However, this has been a persuasive strategy in some cases. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 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. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. 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. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . If performed all at once, FFS usually takes between 4- 8 hours. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. 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. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. While facial feminization surgery has many potential benefits, the decision to proceed . JAMA. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Ainsworth TA, Spiegel JH. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . ENQUIRE NOW. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 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. Some error has occurred while processing your request. FFS is a cost-effective intervention that needs to be covered by insurance policies. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. He has been performing gender surgery since 2005. 3). A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). The doctor said very encouraging. Out-of-pocket costs for FFS. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 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. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. 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. James S, Herman J, Rankin S, et al. https://links.lww.com/PRSGO/B648.) Received for publication February 2, 2021; accepted February 27, 2021. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Location: Bangkok, Thailand. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Finally, you should have an idea of your local resources. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. 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. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. No. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. 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. 6. 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. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Your insurance might have a requirement about length of time in care with them, or degree level. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. P < 0.05 was considered significant. Bariatric Surgery. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Schedule surgery 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. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. 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. Co-insurance past that? 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. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. Leigh JP, Tancredi D, Jerant A, et al. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 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. Capitn L, Simon D, Kaye K, et al. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. The United States . 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. 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. Only patients with insurance authorization decisions were included in this study (n = 40). However, this is starting to change. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 14. 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.) document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. 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%). 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. 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.
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