Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. 2). Ousterhout DK. Dr. Thomas Satterwhite your express consent. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. JAMA Surg. 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. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 2018 Physician Compensation Report. 14. A letter from your primary care provider or whoever prescribes your hormones. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. For example, there are now many hospitals across the . 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). However, this is starting to change. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. 5. Dr. Ellie Zara Ley, MD is an accomplished board-certified plastic surgeon who had more than 15 years of specialized training in plastic, craniofacial and micro surgery before learning the art of Gender Confirmation Surgery. Beginning in June 2021, Dr. Esmonde will serve as a full-time Associate Surgeon with The Meltzer Clinic offering the full spectrum of gender-affirming procedures. I tell everyone to plan for an initial denial- even if FGCS is covered in your plan clearly, its likely that portions of the procedure will be denied as cosmetic. 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. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Furthermore, revisions may be indicated in some patients over time. 2015; 136:560e561e. The benefits of such coverage far exceed the insignificant costs. JAMA. As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. Out-of-pocket costs for FFS. Every state is different so start with Google and reach out to these services in your state, theyre here for you! Canner JK, Harfouch O, Kodadek LM, et al. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. If they are a member of WPATH or other applicable professional associations, they should name that. Available at: 9. 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. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. 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. KP FFS Surgeons. 2). 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). Everyone who is able to fight through it cracks the door open a little wider for the next person. Arch Intern Med. ENQUIRE NOW. Facial feminization surgery: the forehead. Doctors and nurses take good care. The generalizability of the findings presented here is limited by state laws. . Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Braun TL, Braun JL, Hernandez C, et al. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. 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. 8. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. Doximity. 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. 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. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. 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. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. 3. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. In addition, many of them don't take insurance. 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. 1). They submit their own information, information about the procedure being performed, and information about you. 12. 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. 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. However, some insurers are beginning to cover FFS from select surgeons. 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. 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%). He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. 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 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. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Schedule surgery 3). Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Until then, CCTS will continue to require all patients using insurance for . I don't philosophically agree with this. Qual Life Res. 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. Facial Feminization Surgery (FFS) is a group of facial procedures that alter the face to create more classically feminine characteristics, such as a higher brow, a more refined feminine nose, and less pronounced Adams apple. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Only if your insurance provider authorizes a Letter of Agreement. Compared with the published literature, patients within Groups B and C are multi-fold greater than the reported standard estimates in the former study without even taking into account time and costs of post-surgical billing activities. 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. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Are there transgender advocacy groups? generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 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. There are a few limitations in this study that deserve mention. J Gen Intern Med. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. James S, Herman J, Rankin S, et al. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 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. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. 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). Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 1. 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. As an example, the typical timeline for our Group B and C patients is as follows: 1. Choose from multiple implant types and sizes. 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 2020; 8:e2618. 2016. What's your out of pocket max? Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. They accept most major insurances and work to help you get your surgery fully covered whenever possible. You may be trying to access this site from a secured browser on the server. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. I am working from the perspective that you are unable to pay in full and be reimbursed. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Days, whose birth name was Douglas, came out as transgender in January, 2015. You should be able to have easy access to this document through your insurance provider. 2019; 144:11591168. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Submission and review of second level, patient-initiated appeal (1 month); 4. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Plast Reconstr Surg. 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. Gender-Affirming Surgery: Original Article. Prior to meeting with the social worker, patients should complete this assessment document. 2. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 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. 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. Wolters Kluwer Health, Inc. All rights reserved. Simplifying facial feminization surgery using virtual modeling on the female skull. Do you have access to out-of-network providers or in-network only. 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). Have your facial features compromised your safety, making you a target for harassment and violence? *, Time and cost of the insurance approval process for FFS. It involves plastic surgery techniques in which the jaw, chin, cheeks, forehead, nose, and areas surrounding the eyes, ears or lips are changed to create a more feminine appearance. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Finding a Surgeon Integral to this whole process is the FGCS surgeon. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Justine C. Lee, MD, PhD, FACS, University of California, Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960, E-mail: [emailprotected]. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. 2010; 170:17281734. 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. We can't guarantee insurance coverage but we can guarantee to try our hardest! For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Temporal trends in gender-affirming surgery among transgender patients in the United States. Gray R, Nguyen K, Lee JC, et al. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 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. Error bars denote standard error. 1. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Facial feminization surgery (FFS): The permanent . 2016; 137:438448. In total, the time and cost estimate of the insurance appeal process was 10.8 1.0 hours and $855.00 91.53 per patient, respectively. 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. Start with ensuring that you have an in-depth understanding of your insurance benefits. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. https://links.lww.com/PRSGO/B647.). Ask them how many FFS surgeries they perform within a year. 3). 2003; 349:768775. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. $8995. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Support groups? Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Dr. Andrew Kleinberger. From the cohort, 3 subgroups were delineated. 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. Please first read this resource for a general overview of insurance utilization for trans surgery. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. Dr. Freet accepts both insurance and Medicare. 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. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 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 The objective is to soften the facial . 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. Wolters Kluwer Health Care Credit approval amounts can vary from person to person. You will be asked to complete an intake questionnaire before your consultation. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 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). Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. Notes. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Integral to this whole process is the FGCS surgeon. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. This is also the point at which general 201 level guidance ceases to be useful. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 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. 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. Submission and review of physician-initiated appeal (1 month); 3. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 2018; 153:609616. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Second, while complications are not high in FFS, they may occur. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Read more. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Research that Matters. $4985. 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. Look here for licensed dentists practicing in the state. 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. Location: Bangkok, Thailand. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. 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. All rights reserved. Please enable scripts and reload this page. Error bars denote standard error. 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. A total of 36 patients (90.0%) have been approved by insurance. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Historically, FFS hasn't been covered by health insurance or government healthcare. Read more on our Insurance and Finance page. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Some of the procedures included in facial feminization surgery are: Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . 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 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. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Patients were stratified into 3 groups by authorization process. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars.
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