Facial Feminization Surgery: What Is FFS, Hairline - Cleveland Clinic These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. JAMA. Insurance Requirements for Gender Confirmation Surgery - Verywell Health Read this first. 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. Every state is different so start with Google and reach out to these services in your state, theyre here for you! This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Do you have out of network benefits, or are you limited to providers in the network? 8. School-Based Dental Sealants; Licensed Rhode Island Dentists. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Our team will help you set up a MyChart account where you will have the ability to fill this out online. Modeling performed by Padula and colleagues for employer-based insurance plans in Massachusetts indicated that, over the course of 5 years, coverage for transition-related services would lead to societal costs of $0.016 per month per member.3 The authors concluded that the relatively low societal cost, combined with the increase in quality-adjusted life years for transgender patients, supported coverage of transition-related services in employer-based plans. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 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). Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Male-to-female (MTF) facial feminization. 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. 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. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Denver Health to Offer Facial Feminization Gender Confirmation Surgery Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Conveniently Located to Serve Chicago and Illinois. 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. A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. This is their communication with the insurance company verifying that the procedure is covered. Try your local trans advocacy groups, LGBTI legal services, support group, etc. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Health insurance Medical Policies - Trans Health Project 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. 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. Dr. Thomas Satterwhite Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . The administrator hourly compensation set at our institution was used for the cost analysis. 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. 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.). Every insurance company is "difficult" to work with. San Francisco, CA 94108. 14. Your insurance might have a requirement about length of time in care with them, or degree level. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. 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. Two letters from mental health providers. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. 15. Choose from multiple implant types and sizes. 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. How NOT To Choose Your Facial Feminization Surgeon Braun TL, Braun JL, Hernandez C, et al. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Total Staff: 34. 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. I don't philosophically agree with this. A total of 36 patients (90.0%) have been approved by insurance. The doctor said very encouraging. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Until then, CCTS will continue to require all patients using insurance for . How soon can I book a surgery date? Health insurance might not cover surgical procedures considered cosmetic for the cisgender population people whose gender identity matches the one they were assigned at birth even though these procedures are . 6. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 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%). Want to use our data? Requiring letters from therapists and physicians appeals to some hospitals, surgeons, and care providers, who may look at this system as legally defensible if necessary. He has been performing gender surgery since 2005. Dr. Charles Shih. Received for publication February 2, 2021; accepted February 27, 2021. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Plastic and Cosmetic Surgery. Submission and review of physician-initiated appeal (1 month); 3. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. *. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. (link is external) for CGSP. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. 12. 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. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. Dr. Thomas Satterwhite In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Facial Feminization Surgery (FFS) | University of Miami Health System Each patient is different and your expectations and desired results will be discussed fully in your consultation. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. 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. Costs of health care administration in the United States and Canada. . Do you have a deductible to meet? Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Look here for licensed dentists practicing in the state. 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 of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 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. 2). Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Paying for Transgender Surgeries - Investopedia During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. $4985. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. 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 Physician Compensation Report. According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . Privacy Policy (Updated December 15, 2022). This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Transgender health care coverage | HealthCare.gov a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Insurance For Facial Feminization Surgery | Allure Esthetic Procedure. 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. https://links.lww.com/PRSGO/B648.) I always advise people to try with the insurance they have before they switch to another plan. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. While facial feminization surgery has many potential benefits, the decision to proceed . In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Patients were stratified into 3 groups by authorization process. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. 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. You will be asked to complete an intake questionnaire before your consultation. Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. 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. From the cohort, 3 subgroups were delineated. 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. 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. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? 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). Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 2016. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. may email you for journal alerts and information, but is committed 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. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 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. The United States . These procedures may include: Tummy tuck, called abdominoplasty. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. 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. 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. Read more about our Clinics Finance and Insurance Policy here. Wolters Kluwer Health, Inc. All rights reserved. Find a Surgeon for Gender Affirming Surgery - TransHealthCare Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 13. 2). According to the Philadelphia Center for Transgender Surgery,. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 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. 2014; 134:609619. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Facial feminization surgery - Mayo Clinic - Mayo Clinic - Mayo Clinic Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. Price (USD) Forehead Recontouring. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 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. Capitn L, Simon D, Kaye K, et al. 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. 2019; 144:11591168. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. 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. Average months spent from initial facial feminization consultation to final insurance authorization decision. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial.
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