ffs surgeons who take insurance

2. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Facial Feminization Surgery FFS Insurance Coverage FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Padula WV, Heru S, Campbell JD. After a person pays the deductible, Medicare pays 80% of the allowable costs . Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Dr. Facque joined the Gender Confirmation Centers team in September 2020 as a full-time Associate Surgeon specializing in Facial Gender Confirmation Surgery, Top Surgery and Body Contouring. 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. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Your scars may take up to a year to heal. 2016. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Doximity. Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. 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. JAMA. Surgical techniques and analysis of results. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 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? 3. All rights reserved. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 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. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. In addition to administrative time, multi-level appeals required time from the attending craniofacial surgeon for peer-to-peer reviews, writing appeal letters, and patient counseling over the 6-month period, in total averaging 3.6 0.5 hours per patient. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 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.). 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]. Conveniently Located to Serve Chicago and Illinois. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Plast Reconstr Surg. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Ask them how many FFS surgeries they perform within a year. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. 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. However, some insurers are beginning to cover FFS from select surgeons. to maintaining your privacy and will not share your personal information without 13. This process will be long and draining, but it is worth it. Doctors and nurses take good care. Facial Feminization Surgery Cost - American Society of Plastic Surgeons These delicate procedures change the male facial patterns to a softer, feminine appearance. 2016; 31:394401. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Cost of Facial Feminization Surgery (FFS) and Insurance Information Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Call 913-588-6200 to request a consultation. 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 benefits of such coverage far exceed the insignificant costs. 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. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . I always advise people to try with the insurance they have before they switch to another plan. 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. Your insurance might have a requirement about length of time in care with them, or degree level. According to the Philadelphia Center for Transgender Surgery,. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 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. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 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. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. You should be able to have easy access to this document through your insurance provider. 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. Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System I don't philosophically agree with this. 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. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Please try again soon. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. San Francisco, CA 94108. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Facial feminization surgery (FFS): The permanent . Copyright TransHealthCare.org & Trans Media Network, 2011-2022. 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. 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. 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). Facial Feminization Surgery: FFS Surgery in Thailand Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. In addition, many of them don't take insurance. 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. During Your FFS Procedure How long it takes: This depends on what you are having done. Health insurance Medical Policies - Trans Health Project 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. 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. When it comes to facial feminization there is no substitute for experience. https://links.lww.com/PRSGO/B648.) 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. Arch Intern Med. If they are a member of WPATH or other applicable professional associations, they should name that. FFS is a cost-effective intervention that needs to be covered by insurance policies. 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. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . 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. 2018; 153:609616. 4. 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. Plast Reconstr Surg. 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. Please note that before you can schedule . Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Finally, you should have an idea of your local resources. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. The Ins & Outs of Traveling Abroad for FFS Surgery However, this is starting to change. 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. 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. Your message has been successfully sent to your colleague. There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. 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. information about insurance coverage: video.transcendlegal.org 2. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 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. 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%). Male-to-female (MTF) facial feminization. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Does Medicare cover gender reassignment surgery? - Medical News Today 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. Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery Insurance - International Center for Transgender Care If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. Only if your insurance provider authorizes a Letter of Agreement. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . HB2084 (2016) bans gender identity discrimination in health insurance and HB2405 (2022) bans categorical exclusions for gender-affirming care under any health plan, though the law does not . Facial Feminization Surgery: A Guide for the Transgendered Woman. Everyone who is able to fight through it cracks the door open a little wider for the next person. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 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. Have your facial features compromised your safety, making you a target for harassment and violence? $8995. An estimated 90% of all patient consults were approved for FFS under insurance. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery 1. 2). 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.) Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. The administrator hourly compensation set at our institution was used for the cost analysis. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Facial feminization surgery - Doctors & Departments - Mayo Clinic Ultimately this letter is between you and your provider, but here is some sample language that has been helpful to patients I've worked with: "Patient X has been adherent to two years of hormone replacement therapy including (specific estrogen regimen.) Data is temporarily unavailable. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 3). Facial feminization surgery: the forehead. 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. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Wolters Kluwer Health, Inc. All rights reserved. The Case For Facial Feminization Surgery - BuzzFeed News Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY Available at: 2. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Read more about our Clinics Finance and Insurance Policy here. Facial Feminization Surgery Before & After Pictures - RealSelf Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Requested CPT codes are detailed in Supplemental Digital Content 1. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Facial Feminization Surgery (FFS) - University of Utah Please read a few important elements consider when booking. 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. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Requires supporting documentation that indicates specific type of FFS procedures requested. 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. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Body-contouring. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Third, full-face, one-stage FFS is a highly time-consuming surgery due to the multiple anatomical areas addressed at once (averaging 8.5 hours in the senior authors experience). He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. Insurance Requirements for Gender Confirmation Surgery - Verywell Health If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Dr. Andrew Kleinberger. Facial Feminization Surgery - Costs - What does FFS cost? - 2pass Clinic The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. 2018; 80:198204. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. 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. 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.