All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. Transgender women may choose FFS as part of their male-to-female transition process. The doctor said very encouraging. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . 12. 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 has been a persuasive strategy in some cases. 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. Months required for definitive insurance authorization decisions for FFS. 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. Ask them how many FFS surgeries they perform within a year. 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 This is their communication with the insurance company verifying that the procedure is covered. Surgical techniques and analysis of results. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Please note that before you can schedule . 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. Dr. Charles Shih. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. However, this is starting to change. 2016. 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. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Every insurance company is "difficult" to work with. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Only patients with insurance authorization decisions were included in this study (n = 40). 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. 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. 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. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. 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. Please read a few important elements consider when booking. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Some of the procedures included in facial feminization surgery are: 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. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. 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. From the cohort, 3 subgroups were delineated. They accept most major insurances and work to help you get your surgery fully covered whenever possible. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 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. Dr. Canner JK, Harfouch O, Kodadek LM, et al. 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). 1. Days, whose birth name was Douglas, came out as transgender in January, 2015. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. 2). 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. Call 913-588-6200 to request a consultation. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Please try again soon. 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. Available at: 9. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Received for publication February 2, 2021; accepted February 27, 2021. We can't guarantee insurance coverage but we can guarantee to try our hardest! JAMA. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Ousterhout DK. Have your facial features compromised your safety, making you a target for harassment and violence? Tseng P, Kaplan RS, Richman BD, et al. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 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. In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Finding a Surgeon Integral to this whole process is the FGCS surgeon. 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 . For example, there are now many hospitals across the . Do you have a deductible to meet? Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Procedure. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. These procedures may include: Tummy tuck, called abdominoplasty. 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. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Now you will be denied! *, Time and cost of the insurance approval process for FFS. I don't philosophically agree with this. It's an attempt to make the face as attractive as possible for as long as it lasts. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. As with any surgical procedure, there are risks associated with FFS. Wolters Kluwer Health, Inc. All rights reserved. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. surgical techniques and analysis of results. Procedures requested for facial feminization insurance authorization are detailed in Table 2. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Start with ensuring that you have an in-depth understanding of your insurance benefits. 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. This should be sent to you in written form, with the specific reason for the denial included. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. Two letters from mental health providers. . Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Facial feminization surgery (FFS): The permanent . 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. 2). 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). However, some insurers are beginning to cover FFS from select surgeons. 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. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. He has been performing gender surgery since 2005. 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. Submission and review of initial authorization request (1 month); 2. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. N Engl J Med. Simplifying facial feminization surgery using virtual modeling on the female skull. Notes. Choose from multiple implant types and sizes. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Every state is different so start with Google and reach out to these services in your state, theyre here for you! Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Costs of health care administration in the United States and Canada. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Available at: 2. Facial Feminization Surgery (FFS) is a group of facial procedures that alter the face to create more classically feminine characteristics, such as a higher brow, a more refined feminine nose, and less pronounced Adams apple. This guide is 201 level, geared towards those who find themselves covered with an ACA exchange plan or private insurance, as Medicaid processes are much more state specific. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. The United States . 2). Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Hoang H, Bertrand AA, Hu AC, et al. 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. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 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. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. 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). These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. Try your local trans advocacy groups, LGBTI legal services, support group, etc. 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. No. Co-insurance past that? NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Male-to-female (MTF) facial feminization. KP FFS Surgeons. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 2010; 170:17281734. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. 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. 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. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 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. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. JAMA Surg. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Historically, FFS hasn't been covered by health insurance or government healthcare. Support groups? Research that Matters. According to the Philadelphia Center for Transgender Surgery,. 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*,. 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. Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. 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. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Both of these methods are. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Patients were stratified into 3 groups by authorization process. Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. As an example, the typical timeline for our Group B and C patients is as follows: 1. Submission and review of IMR (1 month). If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. 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.). In fact, he is one of the most experienced gender surgeons in the world. 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. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. 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. $8995. Read more. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. Bariatric Surgery. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Upon denial, an IMR is requested directly from the insurance plan. The analysis was done by identifying individual steps involved in the insurance process (Fig. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 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. See all insurance information. 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. These delicate procedures change the male facial patterns to a softer, feminine appearance. may email you for journal alerts and information, but is committed Some error has occurred while processing your request. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs.