Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Dr. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Do you have out of network benefits, or are you limited to providers in the network? According to the Philadelphia Center for Transgender Surgery,. If they are a member of WPATH or other applicable professional associations, they should name that. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Canner JK, Harfouch O, Kodadek LM, et al. 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. 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. Dr. Thomas Satterwhite Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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). 2018; 319:691697. ENQUIRE NOW. N Engl J Med. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 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). 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Read more about our Clinics Finance and Insurance Policy here. Call 913-588-6200 to request a consultation. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 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. 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 lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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. 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. Physician wages across specialties: informing the physician reimbursement debate. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Upon denial, an IMR is requested directly from the insurance plan. You will be asked to complete an intake questionnaire before your consultation. This could be a good time to join (or form!) Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. 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. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. A total of 36 patients (90.0%) have been approved by insurance. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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. 6. 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. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. 5. I always advise people to try with the insurance they have before they switch to another plan. Second, while complications are not high in FFS, they may occur. 2003; 349:768775. Hoang H, Bertrand AA, Hu AC, et al. 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. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Thus, coverage significantly increases accessibility. Two letters from mental health providers. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 13. $8995. 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. 2). Ainsworth TA, Spiegel JH. 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. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. 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. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Transgender women may choose FFS as part of their male-to-female transition process. Complete New Patient Questionnaire. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). https://links.lww.com/PRSGO/B648.). Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Wolters Kluwer Health, Inc. All rights reserved. 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.) Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. Plastic surgery on the face. 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. 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? 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. Both of these methods are. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. The administrator hourly compensation set at our institution was used for the cost analysis. These delicate procedures change the male facial patterns to a softer, feminine appearance. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 14. 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 Ann Plast Surg. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Please refer to theCare Credit websitefor further details. 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. 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 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. 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. Dr. Freet accepts both insurance and Medicare. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Otherwise, your deposit will be applied towards your surgical balance. What's your out of pocket max? Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Prior to meeting with the social worker, patients should complete this assessment document. 2018; 153:609616. Error bars denote standard error. Please read a few important elements consider when booking. your express consent. 2016; 137:438448. 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%). Read more. 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. Facial feminization surgery: the forehead. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. 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. They submit their own information, information about the procedure being performed, and information about you. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 2. Leigh JP, Tancredi D, Jerant A, et al. Ask them how many FFS surgeries they perform within a year. Plast Reconstr Surg. The doctor said very encouraging. This is their communication with the insurance company verifying that the procedure is covered. Submission and review of physician-initiated appeal (1 month); 3. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Capitn L, Simon D, Kaye K, et al. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. The United States . (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. 2010; 19:10191024. 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. Dr. Thomas Satterwhite She has the skill and artistry to help produce the aesthetic goals that transgender and non-binary patients seek with Top Surgery, Breast Augmentation and Facial Gender Confirmation Surgery. 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). One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. 2016; 31:394401. 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Out-of-pocket costs for FFS. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Facial Feminization Surgery: A Guide for the Transgendered Woman. Policy Title: Gender Affirming Surgery. The analysis was done by identifying individual steps involved in the insurance process (Fig. Descriptive statistics were performed for demographic variables. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Notes. 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. 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. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Facial feminization surgery can be covered by health insurance in some instances. The work cannot be changed in any way or used commercially without permission from the journal. 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. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Woolhandler S, Campbell T, Himmelstein DU. 12. 3). These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. 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. Private insurances included health maintenance organizations and preferred provider organization. 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. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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 From the cohort, 3 subgroups were delineated. Submission and review of second level, patient-initiated appeal (1 month); 4. 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. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 2020; 8:e2618. 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 (FFS) Preparation Guide. 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). 1. 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. 1. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Until then, CCTS will continue to require all patients using insurance for . Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female.
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