The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). 1. 11. If performed all at once, FFS usually takes between 4- 8 hours. P < 0.05 was considered significant. 3). . Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 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. How Much Does Facial Feminization Surgery Cost? | RealSelf The Case For Facial Feminization Surgery - BuzzFeed News 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. This is their communication with the insurance company verifying that the procedure is covered. 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. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Your scars may take up to a year to heal. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures, including Top Surgery, Phalloplasty, Vaginoplasty and Facial Feminization Surgery. https://links.lww.com/PRSGO/B648.) 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. I don't philosophically agree with this. J Gen Intern Med. 2018. 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. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? These delicate procedures change the male facial patterns to a softer, feminine appearance. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Dr. Satterwhite is a board-certified Plastic and Craniofacial Surgeon in San Francisco who is dedicated to offering the highest level of surgical care to the transgender community. Post-surgery garments; Medical tests and x-rays; When choosing a board-certified plastic surgeon for facial feminization surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery. How soon can I book a surgery date? 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. During Your FFS Procedure How long it takes: This depends on what you are having done. A total of 36 patients (90.0%) have been approved by insurance. Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System Please first read this resource for a general overview of insurance utilization for trans surgery. 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. 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). Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Facial Feminization Surgery (FFS) in Mexico - MyMediTravel (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. . Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic 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. Research that Matters. Co-insurance past that? Doximity. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Privacy Policy (Updated December 15, 2022). Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Physician wages across specialties: informing the physician reimbursement debate. Plastic and Cosmetic Surgery. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. I always advise people to try with the insurance they have before they switch to another plan. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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 . Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Complete New Patient Questionnaire. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Submission and review of second level, patient-initiated appeal (1 month); 4. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Dr. Charles Shih. Letters - Crane Center for Transgender Surgery If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Facial Feminization Surgery (FSS) Houston and The Woodlands Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. The doctor said very encouraging. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Insurance For Facial Feminization Surgery | Allure Esthetic Care Credit approval amounts can vary from person to person. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu 2. However, California state law stipulates gender non-discrimination in health insurance, thus, Medi-Cal covers all procedures performed specifically for the purposes of gender affirmation. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Estimated costs of obtaining insurance approval for FFS (B). A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Please refer to theCare Credit websitefor further details. How to Pay for Gender-Affirming Surgery - NerdWallet 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. Some of the procedures included in facial feminization surgery are: 2018; 153:609616. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? 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. 7. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. 14. (link is external) for CGSP. 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. Everyone who is able to fight through it cracks the door open a little wider for the next person. Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Received for publication February 2, 2021; accepted February 27, 2021. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Conveniently Located to Serve Chicago and Illinois. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. If it is substantial, they should name their years of experience working with transgender patients. The time spent on the presurgical authorization process for Groups B and C translated to an over 20-fold increase in cost ($855.00 and $988.38, respectively) compared with Group A. Navigation of the insurance process for FFS is challenging and time-consuming; however, coverage is a reality in California provided that multi-level appeals are exhausted. Get a bossy friend to make phone calls with you while you are dealing with the process. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Facial feminization surgery (FFS): The permanent . 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. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. 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. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. As an example, the typical timeline for our Group B and C patients is as follows: 1. This is the point at which you will likely need legal support. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Finding a Surgeon Integral to this whole process is the FGCS surgeon. 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. Your insurance might have a requirement about length of time in care with them, or degree level. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Best Rated Facial Feminization Surgeon (FFS) in the World 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. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 2016. 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. JAMA. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. Facial Feminization Surgery FFS Insurance Coverage Price (USD) Forehead Recontouring. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 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. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. Facial Feminization Miami | The Maercks Institute Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. The analysis was done by identifying individual steps involved in the insurance process (Fig. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Transgender women may choose FFS as part of their male-to-female transition process. Average months spent from initial facial feminization consultation to final insurance authorization decision. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Read this first. 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). 13. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Simplifying facial feminization surgery using virtual modeling on the female skull. Facial feminization surgery can be covered by health insurance in some instances. 6. 3). *. However, the cost can range from $1,847 to $62,000, depending on a few key factors. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. The administrator hourly compensation set at our institution was used for the cost analysis. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 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. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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. Denver Health to Offer Facial Feminization Gender Confirmation Surgery 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. 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. Woolhandler S, Campbell T, Himmelstein DU. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado Facial feminization surgery: the forehead. San Francisco, CA 94108. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Facial Feminization Surgery: A Guide for the Transgendered Woman. The benefits of such coverage far exceed the insignificant costs. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 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. Available at: 2. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Gender-Affirmation Surgery | Transgender Surgery | The University of Total Staff: 34. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). 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 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. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. 2010; 170:17281734. Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . 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). To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Second, while complications are not high in FFS, they may occur. Look here for licensed dentists practicing in the state. 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. 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). Surgery referral assessment requirements | Gender Affirming Health Program Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). Location: Bangkok, Thailand. Some error has occurred while processing your request. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . The United States . A prior authorization is not a guarantee of payment, therefore, you should have funds available to cover all fees and costs related to your surgery should your request be denied. Facial Feminization Surgery Timeline - Gender Confirmation We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Plast Reconstr Surg. Read more about our Clinics Finance and Insurance Policy here. 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.