Arch Intern Med. JAMA. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Do you have a deductible to meet? Surgical techniques and analysis of results. Schedule surgery However, the cost can range from $1,847 to $62,000, depending on a few key factors. 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. Please read a few important elements consider when booking. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. . JAMA Surg. 3). These delicate procedures change the male facial patterns to a softer, feminine appearance. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 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. 2016; 137:438448. No. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. 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. 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. Please first read this resource for a general overview of insurance utilization for trans surgery. Are there transgender advocacy groups? 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. Doctors and nurses take good care. 7. Want to use our data? Gray R, Nguyen K, Lee JC, et al. 13. However, some insurers are beginning to cover FFS from select surgeons. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Please refer to theCare Credit websitefor further details. Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. 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. 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 The analysis was done by identifying individual steps involved in the insurance process (Fig. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 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. 2018; 153:609616. Please try again soon. 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. Facial feminization surgery (FFS): The permanent . If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 2018; 319:691697. Read on to find out why you might pay more or less, and whether the cost is really worth it. Complete New Patient Questionnaire. 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. 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. Simplifying facial feminization surgery using virtual modeling on the female skull. 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. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. 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. Do you have access to out-of-network providers or in-network only. The report of the 2015 U.S. transgender survey. Until then, CCTS will continue to require all patients using insurance for . Read more about our Clinics Finance and Insurance Policy here. Submission and review of physician-initiated appeal (1 month); 3. 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. information about insurance coverage: video.transcendlegal.org 2. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. TransHealthCare.org uses cookies and other tracking technologies to improve your browsing experience on our website, to analyze our website traffic, and to understand where our visitors are coming from. 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. Rhinoplasty. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plast Reconstr Surg. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Facial feminization surgery can be covered by health insurance in some instances. 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. 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). Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). 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. 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. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Dr. Thomas Satterwhite You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 2020; 8:e2618. Woolhandler S, Campbell T, Himmelstein DU. Do you have out of network benefits, or are you limited to providers in the network? Qual Life Res. Ask them how many FFS surgeries they perform within a year. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Body-contouring. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 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. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. 2018. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Facial feminization surgery: the forehead. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. 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. 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. Call 913-588-6200 to request a consultation. Ainsworth TA, Spiegel JH. Only if your insurance provider authorizes a Letter of Agreement. These procedures may include: Tummy tuck, called abdominoplasty. 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. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Your message has been successfully sent to your colleague. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Everyone who is able to fight through it cracks the door open a little wider for the next person. may email you for journal alerts and information, but is committed You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. School-Based Dental Sealants; Licensed Rhode Island Dentists. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. your express consent. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. N Engl J Med. 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. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Price (USD) Forehead Recontouring. If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. 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. After a person pays the deductible, Medicare pays 80% of the allowable costs . The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. $4985. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Wolters Kluwer Health, Inc. All rights reserved. https://links.lww.com/PRSGO/B648.). If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. San Francisco, CA 94108. 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. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . 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? In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Error bars denote standard error. LGBT legal service projects? 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. 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. Policy Title: Gender Affirming Surgery. In fact, he is one of the most experienced gender surgeons in the world. I am working from the perspective that you are unable to pay in full and be reimbursed. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. James S, Herman J, Rankin S, et al. We can't guarantee insurance coverage but we can guarantee to try our hardest! 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. 1. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. You should be able to have easy access to this document through your insurance provider. 3). 3. Estimated costs of obtaining insurance approval for FFS (B). Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. According to the Philadelphia Center for Transgender Surgery,. Get a bossy friend to make phone calls with you while you are dealing with the process. 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. Canner JK, Harfouch O, Kodadek LM, et al. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 2). Your scars may take up to a year to heal. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Gender-Affirming Surgery: Original Article. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. 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. 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. 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. 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. 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. 2018; 80:198204. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. This is also the point at which general 201 level guidance ceases to be useful. How soon can I book a surgery date? Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. 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. https://links.lww.com/PRSGO/B648.) 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. 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. This is the point at which you will likely need legal support. Thus, coverage significantly increases accessibility. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 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. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Dr. Charles Shih. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Available at: 9. Submission and review of initial authorization request (1 month); 2. Capitn L, Simon D, Kaye K, et al. 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. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Ousterhout DK. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Padula WV, Heru S, Campbell JD. They submit their own information, information about the procedure being performed, and information about you. 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. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. 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. 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]. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. ENQUIRE NOW. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine.