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. 2018; 153:609616. Do you have a deductible to meet? Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. 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. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Thus, coverage significantly increases accessibility. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. 7. 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. 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%). Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Support groups? If they are a member of WPATH or other applicable professional associations, they should name that. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. Schedule surgery 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). Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. 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. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. 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. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. *. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. After a person pays the deductible, Medicare pays 80% of the allowable costs . 2). This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Additionally, planning and recovering from any trans surgery is hard! 3). Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Days, whose birth name was Douglas, came out as transgender in January, 2015. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Out-of-pocket costs for FFS. 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.) You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Months required for definitive insurance authorization decisions for FFS. 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. 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. A total of 36 patients (90.0%) have been approved by insurance. Days, a 50-year-old Berkeley resident, had just returned from a month-long trip to Spain in February, where she underwent a procedure known as facial feminization surgery, or FFS. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . 1. J Gen Intern Med. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. 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). Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. 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. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. 10. These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. 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. I am working from the perspective that you are unable to pay in full and be reimbursed. 2015; 136:560e561e. These procedures may include: Tummy tuck, called abdominoplasty. 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. Male-to-female (MTF) facial feminization. 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. Data is temporarily unavailable. 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? Do you have out of network benefits, or are you limited to providers in the network? No. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. 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. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 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. 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. As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. 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. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Policy Issued By: Anthem. In addition, many of them don't take insurance. 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. Lastly, FFS coverage also allows for inclusion of technologies, such as virtual modeling and surgical planning, which may be cost prohibitive in self-pay patients despite evidence that accuracy is improved.10,11. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? information about insurance coverage: video.transcendlegal.org 2. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 2014; 134:609619. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 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. FFS is a cost-effective intervention that needs to be covered by insurance policies. Each patient is different and your expectations and desired results will be discussed fully in your consultation. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. The work cannot be changed in any way or used commercially without permission from the journal. 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. 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. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. These delicate procedures change the male facial patterns to a softer, feminine appearance. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Physician wages across specialties: informing the physician reimbursement debate. From an historical perspective, both private health insurance carriers and government insurance have declined claims for 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. 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? Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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. 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. 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. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Facial feminization surgery: the forehead. Finding a Surgeon Integral to this whole process is the FGCS surgeon. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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 . FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. 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. 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. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Plastic and Cosmetic Surgery. 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. 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. 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 The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Upon denial, an IMR is requested directly from the insurance plan. 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. Read this first. 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 denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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.
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