Notes. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Top facial feminization surgeons will typically undertake 2-3 facial full feminization procedures a week, this equates to at least 100 or more a year. Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. 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. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. The analysis was done by identifying individual steps involved in the insurance process (Fig. Only patients with insurance authorization decisions were included in this study (n = 40). Facial Feminization Surgery: Everything You Need to Know - Verywell Health Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Feminizing surgery - Mayo Clinic Ousterhout DK. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. 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. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 2018; 153:609616. 2010; 170:17281734. Facial Feminization Surgery NYC | Board Certified Plastic Surgeon 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. 2016; 137:438448. Paying for Transgender Surgeries - Investopedia Privacy Policy (Updated December 15, 2022). Research that Matters. 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. Arch Intern Med. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. 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. 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. Male-to-female (MTF) facial feminization. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. 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 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. These delicate procedures change the male facial patterns to a softer, feminine appearance. Policy Title: Gender Affirming Surgery. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. 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. 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. 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. Want to use our data? 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). PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery Plast Reconstr Surg. Doximity. You will be asked to complete an intake questionnaire before your consultation. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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). Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Do you have access to out-of-network providers or in-network only. 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. 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. 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. may email you for journal alerts and information, but is committed 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. your express consent. FFS is a cost-effective intervention that needs to be covered by insurance policies. After a person pays the deductible, Medicare pays 80% of the allowable costs . The time spent on the presurgical authorization process for Groups B and C translated to an over 20-fold increase in cost ($855.00 and $988.38, respectively) compared with Group A. Navigation of the insurance process for FFS is challenging and time-consuming; however, coverage is a reality in California provided that multi-level appeals are exhausted. Some error has occurred while processing your request. Finding a Surgeon Integral to this whole process is the FGCS surgeon. FFS: money and choosing a surgeon : r/Transgender_Surgeries 15. Plast Reconstr Surg Glob Open. 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. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Gender-Affirmation Surgery | Transgender Surgery | The University of 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. 2016. Ultimately this letter is between you and your provider, but here is some sample language that has been helpful to patients I've worked with: "Patient X has been adherent to two years of hormone replacement therapy including (specific estrogen regimen.) P < 0.05 was considered significant. Upon denial, an IMR is requested directly from the insurance plan. As stated above, all patients within this group were covered by private insurance plans that were not within the purview of the State of California and, thus, were not eligible for state intervention. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Temporal trends in gender-affirming surgery among transgender patients in the United States. Error bars denote standard error. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. 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. Procedure. Only if your insurance provider authorizes a Letter of Agreement. Insurance For Facial Feminization Surgery | Allure Esthetic 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 . 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. Schedule surgery ENQUIRE NOW. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Denver Health to Offer Facial Feminization Gender Confirmation Surgery Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 8. 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. 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. Brow Lift. Post Surgery Recovery. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Hu, Allison C. BA*; Dang, Brian N. BS*; Bertrand, Anthony A. MD, MBA*; Jain, Nirbhay S. MD*; Chan, Candace H. BS*; Lee, Justine C. MD, PhD, FACS*,. 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. Health insurance Medical Policies - Trans Health Project A total of 36 patients (90.0%) have been approved by insurance. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons Find a Surgeon for Gender Affirming Surgery - TransHealthCare 2). Facial Feminization Surgery (FSS) Houston and The Woodlands Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. 10. I am working from the perspective that you are unable to pay in full and be reimbursed. 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 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. Plastic and Cosmetic Surgery. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Furthermore, revisions may be indicated in some patients over time. Average months spent from initial facial feminization consultation to final insurance authorization decision. Tseng P, Kaplan RS, Richman BD, et al. 3. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. As with any surgical procedure, there are risks associated with FFS. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Simplifying facial feminization surgery using virtual modeling on the female skull. Facial Feminization in Korea - Everything You Need to Know! 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. Now you will be denied! Ann Plast Surg. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 6. Though WPATH has released the new SOC, it will take insurance companies time to evolve. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. 3). Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Please try again soon. 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 . 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. Woolhandler S, Campbell T, Himmelstein DU. Doctors and nurses take good care. 1. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). 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. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. However, some insurers are beginning to cover FFS from select surgeons. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. . Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 7. Patients were stratified into 3 groups by authorization process. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Two letters from mental health providers. $4985. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 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. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. She has the skill and artistry to help produce the aesthetic goals that transgender and non-binary patients seek with Top Surgery, Breast Augmentation and Facial Gender Confirmation Surgery. This is the point at which you will likely need legal support. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Do you have a deductible to meet? Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. *, Time and cost of the insurance approval process for FFS. 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. Thus, coverage significantly increases accessibility. 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 (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 2). This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 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. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . 4. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). 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. 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. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic Private insurances included health maintenance organizations and preferred provider organization. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 1). Rhinoplasty. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Health insurance might not cover surgical procedures considered cosmetic for the cisgender population people whose gender identity matches the one they were assigned at birth even though these procedures are . Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Procedures requested for facial feminization insurance authorization are detailed in Table 2. According to the Philadelphia Center for Transgender Surgery,. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. However, this is starting to change. LGBT legal service projects? Transgender health care coverage | HealthCare.gov 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. 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. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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.

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