Albert Haynesworth House, Articles F

Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. 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. Your insurance might have a requirement about length of time in care with them, or degree level. 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. If it is substantial, they should name their years of experience working with transgender patients. After a person pays the deductible, Medicare pays 80% of the allowable costs . Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Prior to meeting with the social worker, patients should complete this assessment document. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. 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. 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. 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. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Data is temporarily unavailable. Policy Title: Gender Affirming Surgery. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Brow Lift. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Read this first. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. 11. Start with ensuring that you have an in-depth understanding of your insurance benefits. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. Your message has been successfully sent to your colleague. How Much Does Facial Feminization Surgery Cost? | RealSelf 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. Private insurances included health maintenance organizations and preferred provider organization. For example, there are now many hospitals across the . For Bay Area trans women, facial feminization surgery helps complete Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. 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 Transgender women may choose FFS as part of their male-to-female transition process. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Dr. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Have your facial features compromised your safety, making you a target for harassment and violence? Facial Feminization Surgeons - Gender-Affirming FFS Surgeons In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Insurance and facial feminization surgery - 2pass Clinic There are a few limitations in this study that deserve mention. 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. Do you have a deductible to meet? Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. 15. Physician wages across specialties: informing the physician reimbursement debate. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. How NOT To Choose Your Facial Feminization Surgeon They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. . The concept and treatments were developed with transfeminine patients in mind in the 1980s, led by a San Francisco-based surgeon who devised measurements for a "normal" female appearance by surveying anthropological skeletal records. 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. 2010; 19:10191024. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Requested CPT codes are detailed in Supplemental Digital Content 1. JAMA. Please note that before you can schedule . An estimated 10 patients (25.0%), all with private insurance, underwent an extended approval process requiring multi-level appeals and denial overturn after IMR and frequently, state intervention. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? ENQUIRE NOW. Try your local trans advocacy groups, LGBTI legal services, support group, etc. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. School-Based Dental Sealants; Licensed Rhode Island Dentists. 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. When it comes to facial feminization there is no substitute for experience. The report of the 2015 U.S. transgender survey. Ousterhout DK. A total of 36 patients (90.0%) have been approved by insurance. Plast Reconstr Surg. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Lastly, FFS coverage also allows for inclusion of technologies, such as virtual modeling and surgical planning, which may be cost prohibitive in self-pay patients despite evidence that accuracy is improved.10,11. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Plast Reconstr Surg. One of the major issues among surgeons and patients with regard to insurance coverage for FFS is the lack of understanding of the process as coverage for gender healthcare is highly variable depending on state law and plan variabilities (Table 3). 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. surgical techniques and analysis of results. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Starbucks offers expanded benefits for trans people These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Facial Feminization Surgery (FFS) - University of Utah 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. 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. https://links.lww.com/PRSGO/B648.) We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Plast Reconstr Surg Glob Open. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. You may be trying to access this site from a secured browser on the server. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery 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. 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. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Find a Surgeon for Gender Affirming Surgery - TransHealthCare Leigh JP, Tancredi D, Jerant A, et al. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Tseng P, Kaplan RS, Richman BD, et al. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. 6. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Until then, CCTS will continue to require all patients using insurance for . 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. 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. Rhinoplasty. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Insurance - International Center for Transgender Care Find Dental Health Services: Department of Health - Rhode Island Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Doctors and nurses take good care. 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. 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. Feminizing surgery - Mayo Clinic These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Facial feminization surgery - Mayo Clinic - Mayo Clinic - Mayo Clinic 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. Submission and review of initial authorization request (1 month); 2. Otherwise, your deposit will be applied towards your surgical balance. Some of the procedures included in facial feminization surgery are: Padula WV, Heru S, Campbell JD. 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*,. Dr. Javad Sajan, MD is a Cosmetic, Plastic and Reconstructive Surgeon in Seattle who specializes in Gender-Affirming Surgery including Top Surgery, Breast Augmentation, Body Sculpting and Facial Feminization. Second, while complications are not high in FFS, they may occur. 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. 2018; 319:691697. Received for publication February 2, 2021; accepted February 27, 2021. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Care Credit approval amounts can vary from person to person. The doctor said very encouraging. Historically, FFS hasn't been covered by health insurance or government healthcare. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. 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. 6. Facial Feminization Surgery: A Guide for the Transgendered Woman. (link is external) for CGSP. Total Staff: 34. Denver Health to Offer Facial Feminization Gender Confirmation Surgery 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. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic Surgical techniques and analysis of results. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Insurance Requirements for Gender Confirmation Surgery - Verywell Health Available at: 2. 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. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Read more on our Insurance and Finance page. The format for an appeals process and regulations/law/policy to cite within it vary widely depending on the mix of state and local regulations that apply to your specific plan. Hoang H, Bertrand AA, Hu AC, et al. If they are a member of WPATH or other applicable professional associations, they should name that. 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. I always advise people to try with the insurance they have before they switch to another plan. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. This means that the surgeon is either already in network with your insurance and is willing to send a prior authorization, or has an office willing to do the legwork of doing a letter of agreement with your insurance. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Facial Feminization Surgery (FFS) in Thailand - MyMediTravel Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Arch Intern Med. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Estimated costs of obtaining insurance approval for FFS (B). Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 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 this work, we detailed our institutional experience on obtaining insurance coverage for FFS. What's your out of pocket max? Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Co-insurance past that? (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Months required for definitive insurance authorization decisions for FFS. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa 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. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Best FFS Surgeons: What to Know and Where to Go Facialteam Body-contouring. Submission and review of physician-initiated appeal (1 month); 3. 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. 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.) Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Wolters Kluwer Health, Inc. All rights reserved. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Gender Affirmation Surgery - University of Utah Dr. Andrew Kleinberger. This is called facial feminization surgery. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Your scars may take up to a year to heal. 2019; 144:11591168. 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. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. The work cannot be changed in any way or used commercially without permission from the journal. 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. Dr. Thomas Satterwhite Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. 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.