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. 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 . Procedures requested for facial feminization insurance authorization are detailed in Table 2. Facial feminization surgery (FFS): The permanent . ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Until then, CCTS will continue to require all patients using insurance for . While facial feminization surgery has many potential benefits, the decision to proceed . We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. 2). Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Are there transgender advocacy groups? Please first read this resource for a general overview of insurance utilization for trans surgery. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. You may be trying to access this site from a secured browser on the server. Your insurance might have a requirement about length of time in care with them, or degree level. https://links.lww.com/PRSGO/B648.) Finding a Surgeon Integral to this whole process is the FGCS surgeon. 2018. 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. I don't philosophically agree with this. Procedure. Do you have access to out-of-network providers or in-network only. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. 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. 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. 4. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 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. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Furthermore, revisions may be indicated in some patients over time. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . 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*,. 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. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. School-Based Dental Sealants; Licensed Rhode Island Dentists. He has been performing gender surgery since 2005. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Woolhandler S, Campbell T, Himmelstein DU. 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. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. https://links.lww.com/PRSGO/B648.). 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. *. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. Facial feminization surgery: the forehead. The report of the 2015 U.S. transgender survey. Capitn L, Simon D, Kaye K, et al. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 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 scars may take up to a year to heal. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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 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. Leigh JP, Tancredi D, Jerant A, et al. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. However, this has been a persuasive strategy in some cases. 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. 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. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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.). Otherwise, your deposit will be applied towards your surgical balance. 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. JAMA Surg. $8995. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 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. 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%). Submission and review of physician-initiated appeal (1 month); 3. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. These delicate procedures change the male facial patterns to a softer, feminine appearance. 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. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. This is the point at which you will likely need legal support. However, some insurers are beginning to cover FFS from select surgeons. Simplifying facial feminization surgery using virtual modeling on the female skull. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. 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. 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? Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. KP FFS Surgeons. 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 These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Data is temporarily unavailable. Total Staff: 34. The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. Their credential as an MD/DO/NP/PA/MSW/PHD and signature on an essentially form WPATH conforming letter are not sufficient- they need to impress upon the medical reviewers that they are not simply approving your referral request, but are guiding your care as a treating provider, and that this surgery is part of your care plan. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. may email you for journal alerts and information, but is committed Any reimbursement from the insurance company (if any) would be paid directly to the patient. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. 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. 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 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. 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. However, this is starting to change. 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. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. An estimated 90% of all patient consults were approved for FFS under insurance. See all insurance information. Support groups? San Francisco, CA 94108. Transgender women may choose FFS as part of their male-to-female transition process. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. Costs of health care administration in the United States and Canada. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Some error has occurred while processing your request. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. 1. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Please note that before you can schedule . In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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 . 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. 6. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. your express consent. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Every state is different so start with Google and reach out to these services in your state, theyre here for you! In the rare instance that FFS Surgery is included in your health insurance policy, services may be incomplete or function only on a reimbursement basis. Doximity. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. 3). 2020; 8:e2618. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Choose from multiple implant types and sizes. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? 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). Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Second, while complications are not high in FFS, they may occur. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. 2020 Deschamps-braly clinic. 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. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. 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. 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). Each patient is different and your expectations and desired results will be discussed fully in your consultation. As with any surgical procedure, there are risks associated with FFS. 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. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Physician wages across specialties: informing the physician reimbursement debate. In fact, he is one of the most experienced gender surgeons in the world. 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. 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. 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. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Please read a few important elements consider when booking. 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. Dr. Satterwhite is a board-certified Plastic and Craniofacial Surgeon in San Francisco who is dedicated to offering the highest level of surgical care to the transgender community. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Thus, coverage significantly increases accessibility. 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. 2018; 319:691697. 5. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. Please try again soon. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Canner JK, Harfouch O, Kodadek LM, et al. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Facial Feminization Surgery (FFS) Preparation Guide. This should be sent to you in written form, with the specific reason for the denial included. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . 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. N Engl J Med. 2003; 349:768775. Submission and review of IMR (1 month). a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Additionally, planning and recovering from any trans surgery is hard! 6. The administrator hourly compensation set at our institution was used for the cost analysis. 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). Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. It's an attempt to make the face as attractive as possible for as long as it lasts. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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. Descriptive statistics were performed for demographic variables. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Look here for licensed dentists practicing in the state.
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