Best FFS Surgeons: What to Know and Where to Go Facialteam These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Plast Reconstr Surg. 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. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. *. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 4. This is the point at which you will likely need legal support. 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. We can't guarantee insurance coverage but we can guarantee to try our hardest! Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. 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.) Please read a few important elements consider when booking. As with any surgical procedure, there are risks associated with FFS. Some of the procedures included in facial feminization surgery are: For more information, please refer to our Privacy Policy. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive Feminizing surgery - Mayo Clinic In the rare instance that FFS Surgery is included in your health insurance policy, services may be incomplete or function only on a reimbursement basis. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). Everyone who is able to fight through it cracks the door open a little wider for the next person. 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. 3). Read more. *, Time and cost of the insurance approval process for FFS. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 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. 1. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 1. Rhinoplasty. Care Credit approval amounts can vary from person to person. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Surgery referral assessment requirements | Gender Affirming Health Program This is also the point at which general 201 level guidance ceases to be useful. Location: Bangkok, Thailand. See all insurance information. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Start with ensuring that you have an in-depth understanding of your insurance benefits. Physician wages across specialties: informing the physician reimbursement debate. Support groups? Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Body-contouring. Canner JK, Harfouch O, Kodadek LM, et al. 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. Insurance - International Center for Transgender Care Facial feminization surgery: the forehead. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Submission and review of physician-initiated appeal (1 month); 3. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Woolhandler S, Campbell T, Himmelstein DU. Male-to-female (MTF) facial feminization. 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. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. From the cohort, 3 subgroups were delineated. 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%). 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. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Historically, FFS hasn't been covered by health insurance or government healthcare. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa 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. 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. 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. Read this first. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? 2). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. The doctor said very encouraging. Days, whose birth name was Douglas, came out as transgender in January, 2015. https://links.lww.com/PRSGO/B647.). Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Have your facial features compromised your safety, making you a target for harassment and violence? Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 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 (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. The administrator hourly compensation set at our institution was used for the cost analysis. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). There are a few limitations in this study that deserve mention. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 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 Gender-Affirmation Surgery | Transgender Surgery | The University of Look here for licensed dentists practicing in the state. 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). Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). 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. Facial Feminization Surgery Timeline - Gender Confirmation Estimated costs of obtaining insurance approval for FFS (B). PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related 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. Surgical techniques and analysis of results. Do you have out of network benefits, or are you limited to providers in the network? The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. 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*,. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Facial Feminization in Korea - Everything You Need to Know! Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Facial Feminization Surgery: What Is FFS, Hairline - Cleveland Clinic Data is temporarily unavailable. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. . If performed all at once, FFS usually takes between 4- 8 hours. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). This could be a good time to join (or form!) The Ins & Outs of Traveling Abroad for FFS Surgery With a view to clarifying this issue and answering frequently asked questions, we have compiled the following information in an effort to not only outline how Deschamps-Braly Clinic handles finance and insurance coverage but to also provide general information about how to approach your own health insurance company regarding the cost of your facial feminization. Plast Reconstr Surg Glob Open. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. 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]. Simplifying facial feminization surgery using virtual modeling on the female skull. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons 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. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 7. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Please refer to theCare Credit websitefor further details. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Facial Feminization Surgery | Michigan Medicine - U of M Health In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. 2). Costs of health care administration in the United States and Canada. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Facial feminization surgery: the forehead. Facial Feminization Surgery: FFS Surgery in Thailand Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist). 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. 2). Wolters Kluwer Health
To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Dr. Thomas Satterwhite Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. However, this is starting to change. Some error has occurred while processing your request. Facial Feminization Surgery: A Guide for the Transgendered Woman. Insurance Requirements for Gender Confirmation Surgery - Verywell Health Upon denial, an IMR is requested directly from the insurance plan. KP FFS Surgeons. The analysis was done by identifying individual steps involved in the insurance process (Fig. Please try after some time. 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. 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. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . 8. Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. 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. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. 2. 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. These delicate procedures change the male facial patterns to a softer, feminine appearance. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 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. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. 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. 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. Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Gender-Affirming Surgery Information - East Bay Patients were stratified into 3 groups by authorization process. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. 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.) Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Dr. Thomas Satterwhite 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. Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. Submission and review of second level, patient-initiated appeal (1 month); 4. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 1. 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. 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. Please first read this resource for a general overview of insurance utilization for trans surgery. 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. 2016. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. How Much Does Facial Feminization Surgery Cost? | RealSelf 11. 3. 1). 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. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. What's your out of pocket max? Submission and review of initial authorization request (1 month); 2. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine.