These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Choose from multiple implant types and sizes. 3). 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. Plastic surgery on the face. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). For example, there are now many hospitals across the . 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. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. 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. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Transgender people report years of battles for health insurance coverage Ousterhout DK. The United States . 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. 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. Co-insurance past that? The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Patients were stratified into 3 groups by authorization process. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. 15. 12. This could be a good time to join (or form!) Please first read this resource for a general overview of insurance utilization for trans surgery. 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. Gender-Affirming Surgery: Original Article. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Using Insurance for Facial Gender Confirming Surgery or "FFS" We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their 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. 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. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Every insurance company is "difficult" to work with. Letters - Crane Center for Transgender Surgery 2016; 31:394401. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. These procedures may include: Tummy tuck, called abdominoplasty. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons 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. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Read more about our Clinics Finance and Insurance Policy here. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Care Credit approval amounts can vary from person to person. 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. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. 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. 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. Privacy Policy (Updated December 15, 2022). J Gen Intern Med. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. may email you for journal alerts and information, but is committed 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. Gender-Affirmation Surgery | Transgender Surgery | The University of 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 Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. Denver Health to Offer Facial Feminization Gender Confirmation Surgery Policy Issued By: Anthem. San Francisco, CA 94108. 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. Available at: 2. You should be able to have easy access to this document through your insurance provider. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Best Rated Facial Feminization Surgeon (FFS) in the World 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. Woolhandler S, Campbell T, Himmelstein DU. 2020 Deschamps-braly clinic. 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. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Read on to find out why you might pay more or less, and whether the cost is really worth it. Arch Intern Med. 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. Facial Feminization in Korea - Everything You Need to Know! The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. 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. Total Staff: 34. Some of the procedures included in facial feminization surgery are: Denial overturn was either mandated by the California Department of Managed Healthcare for California-insured plans or by the respective insurance companies for self-insured, employer-based plans under the Employee Retirement Income Security Act of 1974 (ERISA). There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. Policy Title: Gender Affirming Surgery. Facial Feminization Surgery: A Guide for the Transgendered Woman. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. In fact, he is one of the most experienced gender surgeons in the world. Additionally, planning and recovering from any trans surgery is hard! In contrast, FFS under insurance coverage allows for inpatient care, which may be important, particularly to surgeon decision-making as well as patients who may have other medical conditions, pain control issues, or those who travel from long distances. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. ENQUIRE NOW. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 1. Does Medicare Cover Facial Feminization Surgery? Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net 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. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 2014; 134:609619. . Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 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. 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. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 5. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). 2016. 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 . to maintaining your privacy and will not share your personal information without Your scars may take up to a year to heal. 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. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. According to the Philadelphia Center for Transgender Surgery,. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Descriptive statistics were performed for demographic variables. Although your FFS may not be covered by your insurance company its definitely worth doing the research. 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. 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. 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 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. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Simplifying facial feminization surgery using virtual modeling on the female skull. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 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). Among the 26 patients (65.0%) who underwent the standard approval process, 13 patients had Medi-Cal, 4 patients had Medicare, and 9 patients had private insurance. 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. 14. 10. Body-contouring. Plastic and Cosmetic Surgery. Conveniently Located to Serve Chicago and Illinois. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Everyone who is able to fight through it cracks the door open a little wider for the next person. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Only patients with insurance authorization decisions were included in this study (n = 40). Facial Feminization Miami | The Maercks Institute The administrator hourly compensation set at our institution was used for the cost analysis. Integral to this whole process is the FGCS surgeon. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Your message has been successfully sent to your colleague. Braun TL, Braun JL, Hernandez C, et al. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. 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. They submit their own information, information about the procedure being performed, and information about you. 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. 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. From the cohort, 3 subgroups were delineated. Facial Feminization Surgery Cost - American Society of Plastic Surgeons 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. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Insurance Requirements for Gender Confirmation Surgery - Verywell Health See all insurance information. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 2018; 153:609616. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Please enable scripts and reload this page. Best FFS Surgeons: What to Know and Where to Go Facialteam Are there transgender advocacy groups? P < 0.05 was considered significant. During Your FFS Procedure How long it takes: This depends on what you are having done. Ask to speak to people's supervisors. Cost of Facial Feminization Surgery (FFS) and Insurance Information Copyright TransHealthCare.org & Trans Media Network, 2011-2022. 3. Plast Reconstr Surg. How NOT To Choose Your Facial Feminization Surgeon Wolters Kluwer Health, Inc. All rights reserved. https://links.lww.com/PRSGO/B648.). 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. https://links.lww.com/PRSGO/B647.). 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. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. 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. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. Starbucks offers expanded benefits for trans people Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Jess Ting - Plastic and Reconstructive Surgery | Mount Sinai - New York Home Profiles Mount Sinai Doctors Video Visit Available Accepting New Patients Jess Ting, MD Plastic and Reconstructive Surgery 4.6 Star s | 32 Responses CTMS 212-870-8270 View location details Book an Appointment About Me Clinical Focus Video Education & Certifications Awards Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. Only if your insurance provider authorizes a Letter of Agreement. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. You may be trying to access this site from a secured browser on the server. 2020; 8:e2618. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Surgery referral assessment requirements | Gender Affirming Health Program 2018; 80:198204. Facial Feminization Surgery Timeline - Gender Confirmation How to Pay for Gender-Affirming Surgery - NerdWallet Insurance For Facial Feminization Surgery | Allure Esthetic Facial feminization surgery: the forehead. Bariatric Surgery. 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. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 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. However, this has been a persuasive strategy in some cases. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . 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. 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. 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. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Facial Feminization Surgery (FSS) Houston and The Woodlands Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female.