Dr. Charles Shih. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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. 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. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. to maintaining your privacy and will not share your personal information without However, some insurers are beginning to cover FFS from select surgeons. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Finally, you should have an idea of your local resources. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. 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? 3. 7. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 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. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. https://links.lww.com/PRSGO/B648.) 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. Months required for definitive insurance authorization decisions for FFS. Plast Reconstr Surg. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. https://links.lww.com/PRSGO/B648.). Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 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. 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. 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. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 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). 3). NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. . 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. 12. Rhinoplasty. A total of 36 patients (90.0%) have been approved by insurance. Simplifying facial feminization surgery using virtual modeling on the female skull. 2010; 170:17281734. 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. The analysis was done by identifying individual steps involved in the insurance process (Fig. J Gen Intern Med. San Francisco, CA 94108. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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. surgical techniques and analysis of results. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. 5. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. Group A (standard approval) included patients who were approved after undergoing a standard authorization process, such as those with Medi-Cal, Medicare, and private insurance. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. Received for publication February 2, 2021; accepted February 27, 2021. From the cohort, 3 subgroups were delineated. 6. While facial feminization surgery has many potential benefits, the decision to proceed . Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Transgender women may choose FFS as part of their male-to-female transition process. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. Privacy Policy (Updated December 15, 2022). Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. How soon can I book a surgery date? Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Finding a Surgeon Integral to this whole process is the FGCS surgeon. I am working from the perspective that you are unable to pay in full and be reimbursed. 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. 3). The work cannot be changed in any way or used commercially without permission from the journal. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Tseng P, Kaplan RS, Richman BD, et al. Your insurance might have a requirement about length of time in care with them, or degree level. 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. Dr. Thomas Satterwhite 1. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 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. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Bariatric Surgery. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Padula WV, Heru S, Campbell JD. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Modeling performed by Padula and colleagues for employer-based insurance plans in Massachusetts indicated that, over the course of 5 years, coverage for transition-related services would lead to societal costs of $0.016 per month per member.3 The authors concluded that the relatively low societal cost, combined with the increase in quality-adjusted life years for transgender patients, supported coverage of transition-related services in employer-based plans. 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. Co-insurance past that? Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 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. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 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*,. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). 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. your express consent. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. KP FFS Surgeons. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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. 8. Additionally, planning and recovering from any trans surgery is hard! This should be sent to you in written form, with the specific reason for the denial included. Please refer to theCare Credit websitefor further details. 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. 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. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. 2016; 31:394401. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 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. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. 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. Policy Issued By: Anthem. 2018; 153:609616. 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. Body-contouring. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity.
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