Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. (link is external) for CGSP. $8995. Do you have access to out-of-network providers or in-network only. Average months spent from initial facial feminization consultation to final insurance authorization decision. *, Time and cost of the insurance approval process for FFS. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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). Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Canner JK, Harfouch O, Kodadek LM, et al. Dr. Thomas Satterwhite 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. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. 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. Dr. Freet accepts both insurance and Medicare. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. The addition of multi-level appeals in Groups B and C increased the total time for a definitive decision (7.0 and 5.1 months, respectively) and required both surgeon and administrative time to navigate the process (10.8 and 12.0 hours, respectively). 2020; 8:e2618. 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 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. JAMA Surg. 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. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Please first read this resource for a general overview of insurance utilization for trans surgery. Data is temporarily unavailable. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 2014; 134:609619. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Facial Feminization Surgery (FFS) Preparation Guide. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. According to the Philadelphia Center for Transgender Surgery,. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. 11. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 2010; 170:17281734. 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. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Every insurance company is "difficult" to work with. As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. Hoang H, Bertrand AA, Hu AC, et al. 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. https://links.lww.com/PRSGO/B647.). Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. Do you have a deductible to meet? Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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. 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. 3). Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). 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]. A letter from your primary care provider or whoever prescribes your hormones. 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. FGCS is a treatment for gender dysphoria related to the secondary sex characteristics in the face, not a treatment for anxiety caused by the experience of having gender dysphoria or being a transgender person in an unkind world. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization 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. 5. Post Surgery Recovery. Notes. Plast Reconstr Surg Glob Open. James S, Herman J, Rankin S, et al. 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. 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. 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. The Group C authorization process, which resulted in denial of services, consumed a 9-fold higher amount of time (P < 0.001) and 26-fold higher cost (P < 0.001) when compared with Group A (Fig. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. 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. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Additionally, the patients who exited their employer-based plans to buy health insurance on the exchange paid more for health insurance by foregoing employer contributions. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Dr. KathleynBrandstetter. Read more on our Insurance and Finance page. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Our current work highlights the high likelihood of success in FFS coverage under insurance in California, but also details the challenges that plastic surgeons and plastic surgery practices incur for coverage to occur. Two letters from mental health providers. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. The cost of the administrative and attending craniofacial surgeon effort for Groups B and C averaged approximately $900, over 20-fold more than Group A. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Some error has occurred while processing your request. 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 $8995. Choose from multiple implant types and sizes. During Your FFS Procedure How long it takes: This depends on what you are having done. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Arch Intern Med. Error bars denote standard error. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. It's hard for any person to find their voice to self-advocate when such deeply personal needs are up for debate and judgement as "cosmetic" among random insurance company reviewers. Transgender women may choose FFS as part of their male-to-female transition process. Out-of-pocket costs for FFS. Dr. Charles Shih. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Months required for definitive insurance authorization decisions for FFS. 4. ENQUIRE NOW. 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. There are a few limitations in this study that deserve mention. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . 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 We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Upon denial, an IMR is requested directly from the insurance plan. However, some insurers are beginning to cover FFS from select surgeons. 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. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Brow Lift. 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. 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. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. 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). Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 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. Thomas Satterwhite 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. 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. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. This is their communication with the insurance company verifying that the procedure is covered. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). 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. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. 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. 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. Woolhandler S, Campbell T, Himmelstein DU. Doctors and nurses take good care. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. 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. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. The objective is to soften the facial . Get a bossy friend to make phone calls with you while you are dealing with the process. 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. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Both of these methods are. Prior to meeting with the social worker, patients should complete this assessment document. Patients were stratified into 3 groups by authorization process. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Call 913-588-6200 to request a consultation. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. 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. Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. These delicate procedures change the male facial patterns to a softer, feminine appearance. Gray R, Nguyen K, Lee JC, et al. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). LGBT legal service projects? Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Additionally, planning and recovering from any trans surgery is hard! Thus, coverage significantly increases accessibility. However, this is starting to change. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Support groups? Read more. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Ask them how many FFS surgeries they perform within a year. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. From the cohort, 3 subgroups were delineated. Please enable scripts and reload this page. Requires supporting documentation that indicates specific type of FFS procedures requested. Although your FFS may not be covered by your insurance company its definitely worth doing the research. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Submission and review of physician-initiated appeal (1 month); 3. Read on to find out why you might pay more or less, and whether the cost is really worth it. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Finally, you should have an idea of your local resources. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. You will be asked to complete an intake questionnaire before your consultation. Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist). 2018; 153:609616. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. 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. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? 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. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. It's an attempt to make the face as attractive as possible for as long as it lasts. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Co-insurance past that? In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Dr. Facque joined the Gender Confirmation Centers team in September 2020 as a full-time Associate Surgeon specializing in Facial Gender Confirmation Surgery, Top Surgery and Body Contouring. Patients who are definitively denied (Group C) may then exit their employer-based plan and switch to a plan under California jurisdiction on the health insurance exchange. 10. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. 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*,. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. However, the cost can range from $1,847 to $62,000, depending on a few key factors. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS.