Insurance For Facial Feminization Surgery | Allure Esthetic How Much Does Facial Feminization Surgery Cost? | RealSelf Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. 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. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Brow Lift. 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. Have your facial features compromised your safety, making you a target for harassment and violence? Both of these methods are. Your insurance might have a requirement about length of time in care with them, or degree level. Paying for Transgender Surgeries - Investopedia 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. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 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 . Facial Feminization Surgery Timeline - Gender Confirmation Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. 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. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. The Ins & Outs of Traveling Abroad for FFS Surgery Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. 2). Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. 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. 3). 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 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). In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Read more on our Insurance and Finance page. It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. Plast Reconstr Surg. If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. Find a Surgeon for Gender Affirming Surgery - TransHealthCare Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 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. This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. This is also the point at which general 201 level guidance ceases to be useful. Surgical techniques and analysis of results. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. 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. 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. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Research that Matters. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. 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. 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. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. For Bay Area trans women, facial feminization surgery helps complete 11. 2020 Deschamps-braly clinic. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Submission and review of IMR (1 month). Support groups? Surgery referral assessment requirements | Gender Affirming Health Program Second, while complications are not high in FFS, they may occur. While facial feminization surgery has many potential benefits, the decision to proceed . She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. A letter from your primary care provider or whoever prescribes your hormones. Cost of Facial Feminization Surgery (FFS) and Insurance Information They accept most major insurances and work to help you get your surgery fully covered whenever possible. 3). For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 12. 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. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Location: Bangkok, Thailand. Qual Life Res. . Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 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. Look here for licensed dentists practicing in the state. 2). All rights reserved. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. 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. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. P < 0.05 was considered significant. FFS is a cost-effective intervention that needs to be covered by insurance policies. 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. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. Dr. Every insurance company is "difficult" to work with. 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. According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . JAMA. 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. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. Please read a few important elements consider when booking. Patients were stratified into 3 groups by authorization process. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. It's hard for any person to find their voice to self-advocate when such deeply personal needs are up for debate and judgement as "cosmetic" among random insurance company reviewers. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Received for publication February 2, 2021; accepted February 27, 2021. No. Months required for definitive insurance authorization decisions for FFS. Finally, you should have an idea of your local resources. 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. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. https://links.lww.com/PRSGO/B647.). 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. However, this is starting to change. 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? 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). FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 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. From the cohort, 3 subgroups were delineated. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net 1). In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Transgender health care coverage | HealthCare.gov 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. Start with ensuring that you have an in-depth understanding of your insurance benefits. As an example, the typical timeline for our Group B and C patients is as follows: 1. 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. 7. We hope our in-person consultation will answer all of your questions, provide your sense of confidence and also further your excitement of the path you are on. Now you will be denied! He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. 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. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. . He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine Plast Reconstr Surg. The work cannot be changed in any way or used commercially without permission from the journal. A total of 36 patients (90.0%) have been approved by insurance. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Please try again soon. Denver Health to Offer Facial Feminization Gender Confirmation Surgery In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Estimated costs of obtaining insurance approval for FFS (B). Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery Gender-Affirmation Surgery | Transgender Surgery | The University of These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. In addition, many of them don't take insurance. Facial Feminization Surgery Before & After Pictures - RealSelf Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa KP FFS Surgeons. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. 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. 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. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. FFS: paying and picking a surgeon. Freaking out and need advice. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Procedure. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. James S, Herman J, Rankin S, et al. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). 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. Facial Feminization Surgery under Insurance: The University - LWW (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. 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. The doctor said very encouraging. Each letter should state "this procedure is medically necessary treatment. With all letters, I advise providers to be as authoritative in their tone as possible, and to explicitly claim an expert status if appropriate. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. 6. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. 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. 15. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 2). Dr. KathleynBrandstetter. 14. This could be a good time to join (or form!) Complete New Patient Questionnaire. 2. Requires supporting documentation that indicates specific type of FFS procedures requested. 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). Two letters from mental health providers. 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. 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. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 2. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Submission and review of second level, patient-initiated appeal (1 month); 4. Everyone who is able to fight through it cracks the door open a little wider for the next person. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. 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. FFS: money and choosing a surgeon : r/Transgender_Surgeries 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%). Patients who are definitively denied (Group C) may then exit their employer-based plan and switch to a plan under California jurisdiction on the health insurance exchange.

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