Gray R, Nguyen K, Lee JC, et al. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 4. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest. 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. Error bars denote standard error. 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. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Please first read this resource for a general overview of insurance utilization for trans surgery. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. An estimated 90% of all patient consults were approved for FFS under insurance. 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. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Surgical techniques and analysis of results. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 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. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. 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. Requested CPT codes are detailed in Supplemental Digital Content 1. Prior to meeting with the social worker, patients should complete this assessment document. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. However, this has been a persuasive strategy in some cases. 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. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Do you have access to out-of-network providers or in-network only. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. information about insurance coverage: video.transcendlegal.org 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. Months required for definitive insurance authorization decisions for FFS. James S, Herman J, Rankin S, et al. 3). Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Read this first. N Engl J Med. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 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. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 2003; 349:768775. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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 Surgery (FFS) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. 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. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Data is temporarily unavailable. 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. Finally, you should have an idea of your local resources. 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%). From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. If it is substantial, they should name their years of experience working with transgender patients. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 6. https://links.lww.com/PRSGO/B648.) Dr. KathleynBrandstetter. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. You may be trying to access this site from a secured browser on the server. Dr. Freet accepts both insurance and Medicare. Justine C. Lee, MD, PhD, FACS, University of California, Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960, E-mail: [emailprotected]. 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. You will be asked to complete an intake questionnaire before your consultation. 1. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Get a bossy friend to make phone calls with you while you are dealing with the process. 2018; 153:609616. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Plast Reconstr Surg. Read on to find out why you might pay more or less, and whether the cost is really worth it. Total Staff: 34. The administrator hourly compensation set at our institution was used for the cost analysis. Dr. Charles Shih. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. 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. 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. Received for publication February 2, 2021; accepted February 27, 2021. Otherwise, your deposit will be applied towards your surgical balance. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 14. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Transgender women may choose FFS as part of their male-to-female transition process. Compared with the published literature, patients within Groups B and C are multi-fold greater than the reported standard estimates in the former study without even taking into account time and costs of post-surgical billing activities. 2. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. LGBT legal service projects? 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). 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 . School-Based Dental Sealants; Licensed Rhode Island Dentists. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Plastic and Cosmetic Surgery. 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.). J Gen Intern Med. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Private insurances included health maintenance organizations and preferred provider organization. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Plast Reconstr Surg. Hoang H, Bertrand AA, Hu AC, et al. The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. Co-insurance past that? *, Time and cost of the insurance approval process for FFS. 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 10. your express consent. Please read a few important elements consider when booking. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. ENQUIRE NOW. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. 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. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. 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. . Yet, a number of studies have demonstrated that FFS is not only associated with improvement in quality of life for transfeminine patients, but also, for some patients, the most important aspect of transition.47 Although significant barriers exist, an improvement in insurance coverage for FFS has occurred over time, albeit navigation of the process is both laborious and confusing. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. 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. 2018; 80:198204. Every state is different so start with Google and reach out to these services in your state, theyre here for you! 2020; 8:e2618. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. 7. 2016; 31:394401. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 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. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. 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. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. P < 0.05 was considered significant. Doximity. Price (USD) Forehead Recontouring. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 2018; 319:691697. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. They submit their own information, information about the procedure being performed, and information about you. 2). JAMA Surg. Brow Lift. 1). This is also the point at which general 201 level guidance ceases to be useful. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. JAMA. This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. Dr. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. See all insurance information. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. 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. 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. You should be able to have easy access to this document through your insurance provider. 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. . Submission and review of second level, patient-initiated appeal (1 month); 4. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Some of the procedures included in facial feminization surgery are: 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. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. This could be a good time to join (or form!) In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. 1. 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. Facial feminization surgery (FFS): The permanent . We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. This process will be long and draining, but it is worth it. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. Canner JK, Harfouch O, Kodadek LM, et al. 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. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 2). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. 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. Capitn L, Simon D, Kaye K, et al. The analysis was done by identifying individual steps involved in the insurance process (Fig. As with any surgical procedure, there are risks associated with FFS. Post Surgery Recovery. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. What's your out of pocket max? 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. 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. If they are a member of WPATH or other applicable professional associations, they should name that. As an example, the typical timeline for our Group B and C patients is as follows: 1. 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. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Submission and review of IMR (1 month). Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). 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. 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. A prior authorization is not a guarantee of payment, therefore, you should have funds available to cover all fees and costs related to your surgery should your request be denied. Tseng P, Kaplan RS, Richman BD, et al. Everyone who is able to fight through it cracks the door open a little wider for the next person. 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. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures, including Top Surgery, Phalloplasty, Vaginoplasty and Facial Feminization Surgery. 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. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). 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.