Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. 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. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. These delicate procedures change the male facial patterns to a softer, feminine appearance. Have your facial features compromised your safety, making you a target for harassment and violence? The administrator hourly compensation set at our institution was used for the cost analysis. In contrast to Group A, patients who required significant efforts in the form of multi-level appeals, peer-to-peer reviews, and IMRs were designated Groups B and C, depending on ultimate approval versus denial as the outcomes, respectively. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. 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. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. They accept most major insurances and work to help you get your surgery fully covered whenever possible. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 2019; 144:11591168. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 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). 7. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. Dr. Charles Shih. A total of 36 patients (90.0%) have been approved by insurance. 3). These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Ousterhout DK. Facial Feminization Surgery under Insurance: The University - LWW Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. 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. This could be a good time to join (or form!) Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 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. 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. 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). Your message has been successfully sent to your colleague. 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 . Wolters Kluwer Health We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. 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. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Get a bossy friend to make phone calls with you while you are dealing with the process. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Plast Reconstr Surg. 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. After a person pays the deductible, Medicare pays 80% of the allowable costs . Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . 1. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. Conveniently Located to Serve Chicago and Illinois. Submission and review of IMR (1 month). If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Brow Lift. Procedure. Otherwise, your deposit will be applied towards your surgical balance. 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. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 11. A letter from your primary care provider or whoever prescribes your hormones. This is called facial feminization surgery. Using Insurance for Facial Gender Confirming Surgery or "FFS" Find Dental Health Services: Department of Health - Rhode Island Upon denial, an IMR is requested directly from the insurance plan. N Engl J Med. Error bars denote standard error. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 2003; 349:768775. 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. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. 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) in Thailand - MyMediTravel P < 0.05 was considered significant. Want to use our data? 1). Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 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. FFS: paying and picking a surgeon. Freaking out and need advice. Letters - Crane Center for Transgender Surgery Patients were stratified into 3 groups by authorization process. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Facial Feminization Surgery: What You Should Know - Healthline (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 15. 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. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. 1. As with any surgical procedure, there are risks associated with FFS. Every state is different so start with Google and reach out to these services in your state, theyre here for you! 2. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. 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. $4985. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Integral to this whole process is the FGCS surgeon. Your scars may take up to a year to heal. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Facial feminization surgery: the forehead. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. 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. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. While facial feminization surgery has many potential benefits, the decision to proceed . Physician wages across specialties: informing the physician reimbursement debate. 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. Only if your insurance provider authorizes a Letter of Agreement. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Facial Feminization Surgery | Michigan Medicine - U of M Health If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. 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. In the standard approval process (Group A), patients were under both public and certain private insurance plans (39% of all privately insured patients in the cohort). Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Gray R, Nguyen K, Lee JC, et al. 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. I always advise people to try with the insurance they have before they switch to another plan. Gender Affirmation Atlanta GA | Facial Feminization Alpharetta We can't guarantee insurance coverage but we can guarantee to try our hardest! William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 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? Plast Reconstr Surg. Historically, FFS hasn't been covered by health insurance or government healthcare. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. 4. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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 time and costs necessary to achieve approval from insurance plans for FFS are not trivial. 2018 Physician Compensation Report. Out-of-pocket costs for FFS. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 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. 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. Their credential as an MD/DO/NP/PA/MSW/PHD and signature on an essentially form WPATH conforming letter are not sufficient- they need to impress upon the medical reviewers that they are not simply approving your referral request, but are guiding your care as a treating provider, and that this surgery is part of your care plan. Hoang H, Bertrand AA, Hu AC, et al. Furthermore, revisions may be indicated in some patients over time. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Do you have a deductible to meet? JAMA Surg. Please read a few important elements consider when booking. The report of the 2015 U.S. transgender survey. 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. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. 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. 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. 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 - Doctors & Departments - Mayo Clinic She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. 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. Insurance and facial feminization surgery - 2pass Clinic Padula WV, Heru S, Campbell JD. 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. 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. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. may email you for journal alerts and information, but is committed This is also the point at which general 201 level guidance ceases to be useful. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Temporal trends in gender-affirming surgery among transgender patients in the United States. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 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. Facial Feminization in Korea - Everything You Need to Know! Some error has occurred while processing your request. Leigh JP, Tancredi D, Jerant A, et al. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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? Gender-Affirmation Surgery | Transgender Surgery | The University of If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. FHS/FFS (Facial Harmonization Surgery / Facial Feminization Surgery) Metoidioplasty/Phalloplasty Vaginoplasty/Vulvoplasty Classes cover the following material: Surgical options and techniques Surgery planning and pathway at Kaiser Post-operative care and recovery Most sessions also include a patient panel Dr. 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. Our current work highlights the high likelihood of success in FFS coverage under insurance in California, but also details the challenges that plastic surgeons and plastic surgery practices incur for coverage to occur. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. This should be sent to you in written form, with the specific reason for the denial included. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Second, while complications are not high in FFS, they may occur. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Dr. KathleynBrandstetter. 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. *. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Call 913-588-6200 to request a consultation. If they are a member of WPATH or other applicable professional associations, they should name that. The work cannot be changed in any way or used commercially without permission from the journal. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. 8. 2018. This is their communication with the insurance company verifying that the procedure is covered. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top 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*,. 14. The generalizability of the findings presented here is limited by state laws. The analysis was done by identifying individual steps involved in the insurance process (Fig. 2). Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. According to the Philadelphia Center for Transgender Surgery,. 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. Private insurances included health maintenance organizations and preferred provider organization. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. . 2. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. From the cohort, 3 subgroups were delineated. Please refer to theCare Credit websitefor further details. 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. 12. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Surgery referral assessment requirements | Gender Affirming Health Program Schedule surgery 5. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related They submit their own information, information about the procedure being performed, and information about you. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. Modeling performed by Padula and colleagues for employer-based insurance plans in Massachusetts indicated that, over the course of 5 years, coverage for transition-related services would lead to societal costs of $0.016 per month per member.3 The authors concluded that the relatively low societal cost, combined with the increase in quality-adjusted life years for transgender patients, supported coverage of transition-related services in employer-based plans. Qual Life Res. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 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. 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. 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.
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