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 FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. 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. LGBT legal service projects? Copyright TransHealthCare.org & Trans Media Network, 2011-2022. 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. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. Submission and review of physician-initiated appeal (1 month); 3. 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. 3). Only patients with insurance authorization decisions were included in this study (n = 40). Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Submission and review of IMR (1 month). Some of our patients use Care Credit to cover some of the cost of their facial feminization 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. Second, while complications are not high in FFS, they may occur. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. If they are a member of WPATH or other applicable professional associations, they should name that. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. 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. Error bars denote standard error. A letter from your primary care provider or whoever prescribes your hormones. During Your FFS Procedure How long it takes: This depends on what you are having done. Call 913-588-6200 to request a consultation. Do you have out of network benefits, or are you limited to providers in the network? Gender-Affirming Surgery: Original Article. 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. He has been performing gender surgery since 2005. 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). FFS is a cost-effective intervention that needs to be covered by insurance policies. Doctors and nurses take good care. Wolters Kluwer Health Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Ainsworth TA, Spiegel JH. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. These delicate procedures change the male facial patterns to a softer, feminine appearance. Surgical techniques and analysis of results. 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. Are there transgender advocacy groups? Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Ann Plast Surg. 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 These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 2016. 2010; 170:17281734. 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. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Dr. Thomas Satterwhite Ask to speak to people's supervisors. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Each patient is different and your expectations and desired results will be discussed fully in your consultation. 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). In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Plast Reconstr Surg. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. All patients with public insurance (Medi-Cal or Medicare) as well as a small subset of private insurance plans were approved after initial submission of authorization request or did not require approval before surgery (Medicare) (Fig. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Read this first. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. However, this has been a persuasive strategy in some cases. 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. 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. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Historically, FFS hasn't been covered by health insurance or government healthcare. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. *, Time and cost of the insurance approval process for FFS. Furthermore, revisions may be indicated in some patients over time. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . 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. See all insurance information. 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. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. I don't philosophically agree with this. An estimated 90% of all patient consults were approved for FFS under insurance. However, this is starting to change. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Costs of health care administration in the United States and Canada. Capitn L, Simon D, Kaye K, et al. Thus, coverage significantly increases accessibility. San Francisco, CA 94108. 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. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. Patients were stratified into 3 groups by authorization process. 4. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. https://links.lww.com/PRSGO/B648.). This is their communication with the insurance company verifying that the procedure is covered. 8. 2. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 2016; 137:438448. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Body-contouring. Choose from multiple implant types and sizes. . Care Credit approval amounts can vary from person to person. These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. 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. When it comes to facial feminization there is no substitute for experience. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Complete New Patient Questionnaire. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. According to the Philadelphia Center for Transgender Surgery,. 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.) FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. $8995. I always advise people to try with the insurance they have before they switch to another plan. Your scars may take up to a year to heal. Braun TL, Braun JL, Hernandez C, et al. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 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. 2018; 153:609616. Facial feminization surgery can be covered by health insurance in some instances. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. The work cannot be changed in any way or used commercially without permission from the journal. surgical techniques and analysis of results. For more information, please refer to our Privacy Policy. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Though WPATH has released the new SOC, it will take insurance companies time to evolve. How soon can I book a surgery date? If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 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. Policy Title: Gender Affirming Surgery. In fact, he is one of the most experienced gender surgeons in the world. Have your facial features compromised your safety, making you a target for harassment and violence? 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. Get a bossy friend to make phone calls with you while you are dealing with the process. Facial Feminization Surgery: A Guide for the Transgendered Woman. 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. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Policy Issued By: Anthem. 3. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . 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. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Available at: 2. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Plast Reconstr Surg. 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. Please note that before you can schedule . Dr. KathleynBrandstetter. What's your out of pocket max? If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Only if your insurance provider authorizes a Letter of Agreement. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Among the various gender-affirming procedures, facial feminization surgery (FFS) is arguably the most commonly denied surgery, as insurance companies often deem the involved procedures as cosmetic and not medically necessary. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Ousterhout DK. 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. You may be trying to access this site from a secured browser on the server. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. In contrast to Group A, patients who required significant efforts in the form of multi-level appeals, peer-to-peer reviews, and IMRs were designated Groups B and C, depending on ultimate approval versus denial as the outcomes, respectively. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. 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. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. 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. 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. And some health insurance plans do cover the costs associated with facial feminization surgery procedures, so we recommend contacting your insurance provider to find out what is and is not covered under your current plan. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. 2019; 144:11591168. 2020; 8:e2618. 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. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 10. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 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. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. J Gen Intern Med. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. 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. Estimated costs of obtaining insurance approval for FFS (B). 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. 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. You should be able to have easy access to this document through your insurance provider. If it is substantial, they should name their years of experience working with transgender patients. 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. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 11. 1). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. 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. your express consent. 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. Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 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%). No. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Leigh JP, Tancredi D, Jerant A, et al. 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. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. You need an understanding of your insurance benefits in general: What would any covered surgery cost you?

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