Ann Plast Surg. Historically, FFS hasn't been covered by health insurance or government healthcare. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Furthermore, revisions may be indicated in some patients over time. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 2016. A letter from your primary care provider or whoever prescribes your hormones. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. See all insurance information. This could be a good time to join (or form!) In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Body-contouring. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. 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. Plast Reconstr Surg. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 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. Patients were stratified into 3 groups by authorization process. 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. I don't philosophically agree with this. 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. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. 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. 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. 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.) 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. Plastic and Cosmetic Surgery. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 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. You should be able to have easy access to this document through your insurance provider. This is also the point at which general 201 level guidance ceases to be useful. 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Do you have access to out-of-network providers or in-network only. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Dr. Thomas Satterwhite 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. Charles Shih. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. 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. These delicate procedures change the male facial patterns to a softer, feminine appearance. 11. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Surgical techniques and analysis of results. Please read a few important elements consider when booking. These procedures may include: Tummy tuck, called abdominoplasty. Requested CPT codes are detailed in Supplemental Digital Content 1. 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. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. 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. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. 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. Do you have a deductible to meet? Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 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 . Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Padula WV, Heru S, Campbell JD. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Private insurances included health maintenance organizations and preferred provider organization. Submission and review of IMR (1 month). 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. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Physician wages across specialties: informing the physician reimbursement debate. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Days, whose birth name was Douglas, came out as transgender in January, 2015. 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. Thomas Satterwhite Thus, coverage significantly increases accessibility. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. For more information, please refer to our Privacy Policy. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. 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. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. As an example, the typical timeline for our Group B and C patients is as follows: 1. 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. When it comes to facial feminization there is no substitute for experience. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. 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 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. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. If it is substantial, they should name their years of experience working with transgender patients. 2). 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. Rhinoplasty. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. surgical techniques and analysis of results. During Your FFS Procedure How long it takes: This depends on what you are having done. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 14. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. 2018. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). information about insurance coverage: video.transcendlegal.org 2. Want to use our data? 2018; 153:609616. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. With a view to clarifying this issue and answering frequently asked questions, we have compiled the following information in an effort to not only outline how Deschamps-Braly Clinic handles finance and insurance coverage but to also provide general information about how to approach your own health insurance company regarding the cost of your facial feminization. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Dr. Andrew Kleinberger. Support groups? Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. (link is external) for CGSP. 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. The doctor said very encouraging. N Engl J Med. 7. They accept most major insurances and work to help you get your surgery fully covered whenever possible. 2019; 144:11591168. 1. 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 3). Tseng P, Kaplan RS, Richman BD, et al. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Requires supporting documentation that indicates specific type of FFS procedures requested. Descriptive statistics were performed for demographic variables. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Finding a Surgeon Integral to this whole process is the FGCS surgeon. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 3. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. 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 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. 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. The objective is to soften the facial . Please try after some time. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. 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 Location: Bangkok, Thailand. Hoang H, Bertrand AA, Hu AC, et al. No. Your scars may take up to a year to heal. 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. 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. 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. $8995. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). 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. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Otherwise, your deposit will be applied towards your surgical balance. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. 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. 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. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. The administrator hourly compensation set at our institution was used for the cost analysis. $4985. I always advise people to try with the insurance they have before they switch to another plan. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Plast Reconstr Surg. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Canner JK, Harfouch O, Kodadek LM, et al. If they are a member of WPATH or other applicable professional associations, they should name that. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest.