Price (USD) Forehead Recontouring. 2016; 31:394401. 2). How soon can I book a surgery date? Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. KP FFS Surgeons. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. 2018; 319:691697. 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. This guide is 201 level, geared towards those who find themselves covered with an ACA exchange plan or private insurance, as Medicaid processes are much more state specific. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. However, this is starting to change. Facial feminization surgery (FFS): The permanent . For example, some may be reluctant to perform an osteotomy of the anterior table of the frontal bone for setback in an outpatient surgery center and, thus, default to a less aggressive method of frontal bone recontouring, which may be an undercorrection for certain patients. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Your insurance might have a requirement about length of time in care with them, or degree level. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. J Gen Intern Med. Simplifying facial feminization surgery using virtual modeling on the female skull. Wolters Kluwer Health, Inc. All rights reserved. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. Your scars may take up to a year to heal. Male-to-female (MTF) facial feminization. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 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. 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 Do you have a deductible to meet? surgical techniques and analysis of results. Wolters Kluwer Health Days, whose birth name was Douglas, came out as transgender in January, 2015. 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. James S, Herman J, Rankin S, et al. 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. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Plast Reconstr Surg. 6. 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. As an example, the typical timeline for our Group B and C patients is as follows: 1. 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. Tate, who has been with Starbucks for 15 years and now manages a store in Austin, Texas, is one of a growing number of Starbucks partners who have used the company's leading-edge benefits for transgender partners. Physician wages across specialties: informing the physician reimbursement debate. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Co-insurance past that? 8. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Arch Intern Med. Location: Bangkok, Thailand. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. 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. 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. 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. Choose from multiple implant types and sizes. 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. 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. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. 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. Brow Lift. Patients were stratified into 3 groups by authorization process. JCL is additionally supported by the US Department of Veterans Affairs under award number IK2 BX002442 and the National Institutes of Health/NIDCR R01 DE0289098. Woolhandler S, Campbell T, Himmelstein DU. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 2020; 8:e2618. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Procedure. 11. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. 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 . Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Please enable scripts and reload this page. Conveniently Located to Serve Chicago and Illinois. 3). 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. 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? Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. 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. 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. 5. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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.) The report of the 2015 U.S. transgender survey. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 2). An estimated 10 patients (25.0%), all with private insurance, underwent an extended approval process requiring multi-level appeals and denial overturn after IMR and frequently, state intervention. Plast Reconstr Surg. Schedule surgery Everyone who is able to fight through it cracks the door open a little wider for the next person. While facial feminization surgery has many potential benefits, the decision to proceed . 2010; 19:10191024. Get a bossy friend to make phone calls with you while you are dealing with the process. 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. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation 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. 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%). We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. your express consent. Please first read this resource for a general overview of insurance utilization for trans surgery. Hoang H, Bertrand AA, Hu AC, et al. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. Third, full-face, one-stage FFS is a highly time-consuming surgery due to the multiple anatomical areas addressed at once (averaging 8.5 hours in the senior authors experience). Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 10. 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. Doctors and nurses take good care. 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. This process will be long and draining, but it is worth it. 3). Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. 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 Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. 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. 2016. I don't philosophically agree with this. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Dr. Charles Shih. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Furthermore, revisions may be indicated in some patients over time. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . 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. 1). Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. 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). 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). 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. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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. Requested CPT codes are detailed in Supplemental Digital Content 1. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Two letters from mental health providers. Upon denial, an IMR is requested directly from the insurance plan. Privacy Policy (Updated December 15, 2022). These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. 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. 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. The administrator hourly compensation set at our institution was used for the cost analysis. 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). Although your FFS may not be covered by your insurance company its definitely worth doing the research. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage.