2019; 144:11591168. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Though WPATH has released the new SOC, it will take insurance companies time to evolve. This could include either shaving down or entirely re-contouring the forehead/eyesockets/sinus area using osteotomies (cutting and repositioning bones), shaving the jaw line or a sliding genioplasty (reduction and/or re-positioning of the jaw bone), lifting the upper lip, rhinoplasty (nose job), and bringing the hair line further forward, in addition to other various soft tissue facial adjustments and reduction of the adams apple. Surgeons who practice facial gender confirming surgery often have special training in reconstructing facial features using bone grafting beyond a traditional plastic surgery residency. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 7. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Plast Reconstr Surg. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. The administrator hourly compensation set at our institution was used for the cost analysis. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 2018; 319:691697. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 2016; 31:394401. 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. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. N Engl J Med. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 2. Doximity. Average months spent from initial facial feminization consultation to final insurance authorization decision. 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. Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. https://links.lww.com/PRSGO/B647.). Private insurances included health maintenance organizations and preferred provider organization. Estimated costs of obtaining insurance approval for FFS (B). They submit their own information, information about the procedure being performed, and information about you. San Francisco, CA 94108. 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. 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). Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Otherwise, your deposit will be applied towards your surgical balance. 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. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. Please try after some time. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Notes. Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. Facial feminization surgery (FFS): The permanent . This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. From the cohort, 3 subgroups were delineated. I always advise people to try with the insurance they have before they switch to another plan. Read more. 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. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Prior to meeting with the social worker, patients should complete this assessment document. Post Surgery Recovery. Dr. Andrew Kleinberger. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 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. However, this has been a persuasive strategy in some cases. Policy Title: Gender Affirming Surgery. Woolhandler S, Campbell T, Himmelstein DU. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. Our team will help you set up a MyChart account where you will have the ability to fill this out online. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Want to use our data? Plast Reconstr Surg. 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. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). 2). your express consent. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. 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. If they are a member of WPATH or other applicable professional associations, they should name that. 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. The generalizability of the findings presented here is limited by state laws. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the 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. Call 913-588-6200 to request a consultation. to maintaining your privacy and will not share your personal information without
Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. 5. 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. Lastly, FFS coverage also allows for inclusion of technologies, such as virtual modeling and surgical planning, which may be cost prohibitive in self-pay patients despite evidence that accuracy is improved.10,11. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Read this first. Descriptive statistics were performed for demographic variables. Choose from multiple implant types and sizes. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. I don't philosophically agree with this. 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. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Plastic and Cosmetic Surgery. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. 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. Total Staff: 34. 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. For example, there are now many hospitals across the . Available at: 9. 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. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Complete New Patient Questionnaire. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Facial feminization surgery: the forehead. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Padula WV, Heru S, Campbell JD. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. If performed all at once, FFS usually takes between 4- 8 hours. 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. School-Based Dental Sealants; Licensed Rhode Island Dentists. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. 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. Although your FFS may not be covered by your insurance company its definitely worth doing the research. 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. Bariatric Surgery. Plastic surgery on the face. Start with ensuring that you have an in-depth understanding of your insurance benefits. You will be asked to complete an intake questionnaire before your consultation. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). The objective is to soften the facial . Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Your message has been successfully sent to your colleague. Try your local trans advocacy groups, LGBTI legal services, support group, etc. . The Group C authorization process, which resulted in denial of services, consumed a 9-fold higher amount of time (P < 0.001) and 26-fold higher cost (P < 0.001) when compared with Group A (Fig. 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). One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Dr. KathleynBrandstetter. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 2018; 153:609616. However, this is starting to change. 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 Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Everyone who is able to fight through it cracks the door open a little wider for the next person. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. 2018 Physician Compensation Report. Arch Intern Med. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Care Credit approval amounts can vary from person to person. 1. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Finally, you should have an idea of your local resources. I could go on about this, but I hate to further the expectation that you must be very mentally ill in order for the "extreme" treatment of FGCS to be warranted. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 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. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Gender-Affirming Surgery: Original Article. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. 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. Requiring letters from therapists and physicians appeals to some hospitals, surgeons, and care providers, who may look at this system as legally defensible if necessary. Procedures requested for facial feminization insurance authorization are detailed in Table 2. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. All rights reserved. Please first read this resource for a general overview of insurance utilization for trans surgery. 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 . Months required for definitive insurance authorization decisions for FFS. Privacy Policy (Updated December 15, 2022). In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. We can't guarantee insurance coverage but we can guarantee to try our hardest! As with any surgical procedure, there are risks associated with 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. 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. Have your facial features compromised your safety, making you a target for harassment and violence? Thus, coverage significantly increases accessibility. 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. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. 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. The benefits of such coverage far exceed the insignificant costs. However, some insurers are beginning to cover FFS from select surgeons. Generally, one provider should have a doctoral level degree (PhD, DSW, Psychiatrist MD) and the other can have a masters level degree (MSW, MHC, etc.) Gray R, Nguyen K, Lee JC, et al. Dr. Freet accepts both insurance and Medicare. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. 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. 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 These procedures may include: Tummy tuck, called abdominoplasty. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. 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. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). The cost of the administrative and attending craniofacial surgeon effort for Groups B and C averaged approximately $900, over 20-fold more than Group A. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. Ask to speak to people's supervisors. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Plast Reconstr Surg. According to the Philadelphia Center for Transgender Surgery,. 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. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Price (USD) Forehead Recontouring. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. 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. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 3). What's your out of pocket max? Facial Feminization Surgery (FFS) Preparation Guide. Dr. Charles Shih. 2). 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. 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. 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. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . 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. 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. 2016. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. 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. 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. Requested CPT codes are detailed in Supplemental Digital Content 1. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Facial Feminization Surgery (FFS) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. A letter from your primary care provider or whoever prescribes your hormones. 8. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Do you have a deductible to meet? Read more on our Insurance and Finance page. It's an attempt to make the face as attractive as possible for as long as it lasts. JAMA. J Gen Intern Med. James S, Herman J, Rankin S, et al. I am working from the perspective that you are unable to pay in full and be reimbursed. 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. 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. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. Two letters from mental health providers. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. JAMA Surg. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Tseng P, Kaplan RS, Richman BD, et al. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization 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. Dr. Thomas Satterwhite In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. 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. No. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. An estimated 90% of all patient consults were approved for FFS under insurance. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 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. Submission and review of physician-initiated appeal (1 month); 3. The United States . Upon denial, an IMR is requested directly from the insurance plan. Finding a Surgeon Integral to this whole process is the FGCS surgeon. 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. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries.