However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. 7. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? . 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. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Support groups? Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Both of these methods are. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net 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. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Starbucks offers expanded benefits for trans people 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. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. In total, the time and cost estimate of the insurance appeal process was 10.8 1.0 hours and $855.00 91.53 per patient, respectively. Brow Lift. Facial feminization surgery (FFS): The permanent . In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. Dr. Thomas Satterwhite Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. 2015; 136:560e561e. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. As with any surgical procedure, there are risks associated with FFS. Dr. Javad Sajan - Facial Feminization Surgery (FFS) in Seattle 2). This is their communication with the insurance company verifying that the procedure is covered. Denver Health to Offer Facial Feminization Gender Confirmation Surgery As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 15. A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Data is temporarily unavailable. 2016; 137:438448. 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. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 1. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Thus, coverage significantly increases accessibility. 8. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. The United States . 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. I always advise people to try with the insurance they have before they switch to another plan. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Care Credit approval amounts can vary from person to person. 2018; 80:198204. Doctors and nurses take good care. 2016. Read this first. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine 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. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. 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. Canner JK, Harfouch O, Kodadek LM, et al. Find Dental Health Services: Department of Health - Rhode Island (link is external) for CGSP. 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. Padula WV, Heru S, Campbell JD. 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. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. Do you have a deductible to meet? The administrator hourly compensation set at our institution was used for the cost analysis. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. 3). Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 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. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. 2018. 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. When it comes to facial feminization there is no substitute for experience. N Engl J Med. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna 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. 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. JAMA Surg. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Transgender women may choose FFS as part of their male-to-female transition process. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. The report of the 2015 U.S. transgender survey. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. Schedule surgery Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. Facial feminization surgery can be covered by health insurance in some instances. 2. Thus, coverage significantly increases accessibility. Requires supporting documentation that indicates specific type of FFS procedures requested. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 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 [email protected] Policy Issued By: Anthem. Bariatric Surgery. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Some of the procedures included in facial feminization surgery are: 2020; 8:e2618. 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. As many professions say, past performance does not guarantee future results. However, the tide of change is beginning to roll in- often where Medicaid begins, private plans will be forced to follow, so the clear coverage in California and New York bodes well for everyone. Available at: 2. Ask to speak to people's supervisors. Read on to find out why you might pay more or less, and whether the cost is really worth it. information about insurance coverage: video.transcendlegal.org 2. 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. Facial Feminization Surgery | Michigan Medicine - U of M Health Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. San Francisco, CA 94108. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 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. 1. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. As stated above, all patients within this group were covered by private insurance plans that were not within the purview of the State of California and, thus, were not eligible for state intervention. *, Time and cost of the insurance approval process for FFS. Plast Reconstr Surg. Feminizing surgery - Mayo Clinic 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. Please first read this resource for a general overview of insurance utilization for trans 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. Choose from multiple implant types and sizes. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. Facial Feminization Surgery Before & After Pictures - RealSelf In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. This could include either shaving down or entirely re-contouring the forehead/eyesockets/sinus area using osteotomies (cutting and repositioning bones), shaving the jaw line or a sliding genioplasty (reduction and/or re-positioning of the jaw bone), lifting the upper lip, rhinoplasty (nose job), and bringing the hair line further forward, in addition to other various soft tissue facial adjustments and reduction of the adams apple. Surgeons who practice facial gender confirming surgery often have special training in reconstructing facial features using bone grafting beyond a traditional plastic surgery residency. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. A letter from your primary care provider or whoever prescribes your hormones. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Find a Surgeon for Gender Affirming Surgery - TransHealthCare Out-of-pocket costs for FFS. https://links.lww.com/PRSGO/B647.). Gender-Affirming Surgery Information - East Bay 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]. FFS: paying and picking a surgeon. Freaking out and need advice. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. TransHealthCare.org uses cookies and other tracking technologies to improve your browsing experience on our website, to analyze our website traffic, and to understand where our visitors are coming from. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. Requested CPT codes are detailed in Supplemental Digital Content 1. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Estimated costs of obtaining insurance approval for FFS (B). One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Additionally, planning and recovering from any trans surgery is hard! Plast Reconstr Surg.

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