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Surgical techniques and analysis of results. 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. 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%). All rights reserved. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. However, some insurers are beginning to cover FFS from select surgeons. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 2016; 31:394401. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 10. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. The analysis was done by identifying individual steps involved in the insurance process (Fig. 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 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. 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. Read on to find out why you might pay more or less, and whether the cost is really worth it. 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). 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. 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*,. Facial Reconstruction: Gender affirming facial surgery is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age; and In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. 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. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Procedure. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. 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. 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 NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Have your facial features compromised your safety, making you a target for harassment and violence? 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. 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! Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Both of these methods are. Post-surgery garments; Medical tests and x-rays; When choosing a board-certified plastic surgeon for facial feminization surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery. Error bars denote standard error. 2014; 134:609619. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Price (USD) Forehead Recontouring. 2018; 319:691697. 2010; 170:17281734. 2020 Deschamps-braly clinic. 15. JAMA Surg. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. 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. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. Arch Intern Med. Plastic and Cosmetic 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. 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. Second, while complications are not high in FFS, they may occur. All patients with public insurance (Medi-Cal or Medicare) as well as a small subset of private insurance plans were approved after initial submission of authorization request or did not require approval before surgery (Medicare) (Fig. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. FFS is a cost-effective intervention that needs to be covered by insurance policies. As an example, the typical timeline for our Group B and C patients is as follows: 1. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. The structure of this system sucks, but it's the one in which you find yourself and it is your responsibility to make it work for you. 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. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. 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. 7. Integral to this whole process is the FGCS surgeon. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . 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. 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. Dr. Charles Shih. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Leigh JP, Tancredi D, Jerant A, et al. You will be asked to complete an intake questionnaire before your consultation. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Conveniently Located to Serve Chicago and Illinois. Ousterhout DK. If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. Plastic surgery on the face. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Although your FFS may not be covered by your insurance company its definitely worth doing the research. 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. Do you have out of network benefits, or are you limited to providers in the network? 2020; 8:e2618. No. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 2). Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. These delicate procedures change the male facial patterns to a softer, feminine appearance. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Wolters Kluwer Health Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Body-contouring. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. information about insurance coverage: video.transcendlegal.org 2. Brow Lift. The report of the 2015 U.S. transgender survey. 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. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Only if your insurance provider authorizes a Letter of Agreement. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Ainsworth TA, Spiegel JH. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Gray R, Nguyen K, Lee JC, et al. 3. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. 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. https://links.lww.com/PRSGO/B648.) We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Everyone who is able to fight through it cracks the door open a little wider for the next person. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. 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. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. If they are a member of WPATH or other applicable professional associations, they should name that. 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. Wolters Kluwer Health, Inc. All rights reserved. Estimated costs of obtaining insurance approval for FFS (B). Read more about our Clinics Finance and Insurance Policy here. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 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? Ask them how many FFS surgeries they perform within a year. 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. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. While facial feminization surgery has many potential benefits, the decision to proceed . Read this first. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. This could be a good time to join (or form!) He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. Please try after some time. Want to use our data? San Francisco, CA 94108. However, this is starting to change. $8995. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. In the standard approval process (Group A), patients were under both public and certain private insurance plans (39% of all privately insured patients in the cohort). These procedures may include: Tummy tuck, called abdominoplasty. 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. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. He has been performing gender surgery since 2005. Plast Reconstr Surg. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Complete New Patient Questionnaire. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. 11. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Your insurance might have a requirement about length of time in care with them, or degree level. 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. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. How soon can I book a surgery date? Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 1. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. Facial feminization surgery (FFS): The permanent . His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. 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. However, this has been a persuasive strategy in some cases. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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 . In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. may email you for journal alerts and information, but is committed One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. This is called facial feminization surgery. Policy Issued By: Anthem. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? 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. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. For example, some may be reluctant to perform an osteotomy of the anterior table of the frontal bone for setback in an outpatient surgery center and, thus, default to a less aggressive method of frontal bone recontouring, which may be an undercorrection for certain patients. 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. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). FGCS is a treatment for gender dysphoria related to the secondary sex characteristics in the face, not a treatment for anxiety caused by the experience of having gender dysphoria or being a transgender person in an unkind world. A total of 36 patients (90.0%) have been approved by insurance. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery.

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