James S, Herman J, Rankin S, et al. They submit their own information, information about the procedure being performed, and information about you. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Ainsworth TA, Spiegel JH. In fact, he is one of the most experienced gender surgeons in the world. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. 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. 6. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. I am working from the perspective that you are unable to pay in full and be reimbursed. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. 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 average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. 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 . 2016; 31:394401. For people without local connections, the facebook group, " FFS Facial Feminization Surgery / Transgender TG TS " and the FFS Forums on susans.org are good places to seek community support as well. Facial Feminization Surgery Timeline - Gender Confirmation 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. The generalizability of the findings presented here is limited by state laws. Look here for licensed dentists practicing in the state. How to Pay for Gender-Affirming Surgery - NerdWallet Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. The Case For Facial Feminization Surgery - BuzzFeed News One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. Using Insurance for Facial Gender Confirming Surgery or "FFS" Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. This should be sent to you in written form, with the specific reason for the denial included. Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY 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). Otherwise, your deposit will be applied towards your surgical balance. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. Only patients with insurance authorization decisions were included in this study (n = 40). 1. 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. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 14. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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. The objective is to soften the facial . 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. There are a few limitations in this study that deserve mention. As an example, the typical timeline for our Group B and C patients is as follows: 1. Private insurances included health maintenance organizations and preferred provider organization. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. Find Dental Health Services: Department of Health - Rhode Island 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. Plastic and Cosmetic Surgery. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. 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. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. No. (link is external) for CGSP. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). Read more on our Insurance and Finance page. Every state is different so start with Google and reach out to these services in your state, theyre here for you! 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. 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. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 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. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Facial Feminization in Korea - Everything You Need to Know! Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu 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.). Plastic surgery on the face. 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. Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. A total of 36 patients (90.0%) have been approved by insurance. Price (USD) Forehead Recontouring. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 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. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . 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. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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%). document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 2018. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Facial Feminization Surgery - Need FFS? Find the Best FFS Surgeons JCL is additionally supported by the US Department of Veterans Affairs under award number IK2 BX002442 and the National Institutes of Health/NIDCR R01 DE0289098. 2018; 153:609616. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Gender Affirmation Surgery - University of Utah Support groups? 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. I always advise people to try with the insurance they have before they switch to another plan. 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. 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. Error bars denote standard error. Some of the procedures included in facial feminization surgery are: Submission and review of initial authorization request (1 month); 2. Physician wages across specialties: informing the physician reimbursement debate. 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. It's an attempt to make the face as attractive as possible for as long as it lasts. Until then, CCTS will continue to require all patients using insurance for . One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Facial Feminization Surgeons - Gender-Affirming FFS Surgeons Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa Cost of Facial Feminization Surgery (FFS) and Insurance Information 2010; 19:10191024. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. 2003; 349:768775. 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 identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. This could be a good time to join (or form!) 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. Submission and review of IMR (1 month). Most other insurance plans do not cover FFS and consider it as cosmetic 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. Do you have access to out-of-network providers or in-network only. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Surgery referral assessment requirements | Gender Affirming Health Program Dr. KathleynBrandstetter. These procedures may include: Tummy tuck, called abdominoplasty. Paying for Transgender Surgeries - Investopedia 2. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive 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. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. . Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Do you have out of network benefits, or are you limited to providers in the network? Letters - Crane Center for Transgender Surgery Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Facial feminization surgery (FFS): The permanent . Facial Feminization Surgery (FFS) | Gender Affirming Health Program See all insurance information. Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. Gender-Affirming Surgery Information - East Bay 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. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Insurance and facial feminization surgery - 2pass Clinic insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Doximity. 3). 6. 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. 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. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. San Francisco, CA 94108. 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. Historically, FFS hasn't been covered by health insurance or government healthcare. 5. *, Time and cost of the insurance approval process for FFS. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Additionally, planning and recovering from any trans surgery is hard! Read on to find out why you might pay more or less, and whether the cost is really worth it. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. They accept most major insurances and work to help you get your surgery fully covered whenever possible. 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. 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. Conveniently Located to Serve Chicago and Illinois. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Dr. Javad Sajan - Facial Feminization Surgery (FFS) in Seattle Facial Feminization Surgery (FFS) | Johns Hopkins Medicine 2010; 170:17281734. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. 2020 Deschamps-braly clinic. Does Medicare Cover Facial Feminization Surgery? However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. 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. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Both of these methods are. Capitn L, Simon D, Kaye K, et al. J Gen Intern Med. He has been performing gender surgery since 2005. Please first read this resource for a general overview of insurance utilization for trans surgery. Insurance - International Center for Transgender Care Leigh JP, Tancredi D, Jerant A, et al. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Rhinoplasty. 3. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Finally, you should have an idea of your local resources. 2). 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. 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. Plast Reconstr Surg. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Only if your insurance provider authorizes a Letter of Agreement. Facial Feminization Surgery NYC | Board Certified Plastic Surgeon Brow Lift. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. As with any surgical procedure, there are risks associated with FFS. These delicate procedures change the male facial patterns to a softer, feminine appearance. If performed all at once, FFS usually takes between 4- 8 hours. Prior to meeting with the social worker, patients should complete this assessment document. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 2018; 80:198204. Facial Feminization Surgery under Insurance: The University - LWW Co-insurance past that? If they are a member of WPATH or other applicable professional associations, they should name that. When it comes to facial feminization there is no substitute for experience. Policy Issued By: Anthem. Available at: 2. Lastly, a third subgroup of patients (Group C), all with private insurance, were denied for surgery despite multi-level appeals, peer-to-peer discussions, and IMR. 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. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 10. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. 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.