Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. I don't philosophically agree with this. Look here for licensed dentists practicing in the state. Facial Feminization Surgery under Insurance: The University - LWW The Ins & Outs of Traveling Abroad for FFS Surgery 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. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic Plast Reconstr Surg Glob Open. Schedule surgery In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Plast Reconstr Surg. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. The objective is to soften the facial . 1. Please read a few important elements consider when booking. 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 . They accept most major insurances and work to help you get your surgery fully covered whenever possible. 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. 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. 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 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. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. James S, Herman J, Rankin S, et al. 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. 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. This should be sent to you in written form, with the specific reason for the denial included. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Procedure. I always advise people to try with the insurance they have before they switch to another plan. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado Furthermore, revisions may be indicated in some patients over time. For example, there are now many hospitals across the . Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Finally, you should have an idea of your local resources. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. He has been performing gender surgery since 2005. Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. 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. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Only patients with insurance authorization decisions were included in this study (n = 40). Read more on our Insurance and Finance page. . Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. 6. Facial Feminization Surgery: Everything You Need to Know - Verywell Health We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Now you will be denied! Are there transgender advocacy groups? 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. School-Based Dental Sealants; Licensed Rhode Island Dentists. 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. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Dr. Freet accepts both insurance and Medicare. 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. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). 2. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 6. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Notes. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Plast Reconstr Surg. 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. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. 2018; 153:609616. Thus, coverage significantly increases accessibility. 3). 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. 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. Care Credit approval amounts can vary from person to person. FFS is a cost-effective intervention that needs to be covered by insurance policies. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Transgender people report years of battles for health insurance coverage We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. There are 301 level topics not covered here- going out of network to an office who will only give you CPT codes performed, getting a network exception to go to a provider with skills not available among in-network surgeons, etc. Some error has occurred while processing your request. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. 1. 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. $8995. Facial feminization surgery - Doctors & Departments - Mayo Clinic LGBT legal service projects? Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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 Submission and review of IMR (1 month). Each patient is different and your expectations and desired results will be discussed fully in your consultation. Both of these methods are. Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. 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. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). Arch Intern Med. Private insurances included health maintenance organizations and preferred provider organization. Feminizing surgery - Mayo Clinic Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. Policy Issued By: Anthem. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. Dr. Charles Shih. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Insurance - International Center for Transgender Care Read this first. Gender-Affirming Surgery Information - East Bay Find Dental Health Services: Department of Health - Rhode Island Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. While facial feminization surgery has many potential benefits, the decision to proceed . Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. The administrator hourly compensation set at our institution was used for the cost analysis. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 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). The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). Though WPATH has released the new SOC, it will take insurance companies time to evolve. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. 2014; 134:609619. Capitn L, Simon D, Kaye K, et al. Out-of-pocket costs for FFS. FFS: money and choosing a surgeon : r/Transgender_Surgeries This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. This could be a good time to join (or form!) JAMA. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Please try again soon. https://links.lww.com/PRSGO/B647.). Find a Surgeon for Gender Affirming Surgery - TransHealthCare 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. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Available at: 9. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. N Engl J Med. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. How to Pay for Gender-Affirming Surgery - NerdWallet However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Submission and review of physician-initiated appeal (1 month); 3. 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 2016. 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. may email you for journal alerts and information, but is committed Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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.) However, this is starting to change. However, some insurers are beginning to cover FFS from select surgeons. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. If performed all at once, FFS usually takes between 4- 8 hours. 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. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 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. 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. Read more about our Clinics Finance and Insurance Policy here.