11. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Policy Title: Gender Affirming Surgery. According to the Philadelphia Center for Transgender Surgery,. 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. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. (link is external) for CGSP. 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. Months required for definitive insurance authorization decisions for FFS. The pre-surgical authorization process for patients in Groups B and C, constituting 60.8% of all private insurance patients in our cohort, is highly time-consuming due to the individual review periods required for each level. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. This could be a good time to join (or form!) Procedure. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. You may be trying to access this site from a secured browser on the server. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Some of the procedures included in facial feminization surgery are: The report of the 2015 U.S. transgender survey. P < 0.05 was considered significant. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 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. 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. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Facial feminization surgery: the forehead. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. Conveniently Located to Serve Chicago and Illinois. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). LGBT legal service projects? Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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). 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. In addition, many of them don't take insurance. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. 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. You will be asked to complete an intake questionnaire before your consultation. You should be able to have easy access to this document through your insurance provider. Read more about our Clinics Finance and Insurance Policy here. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Plast Reconstr Surg. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. Facial Reconstruction: Gender affirming facial surgery is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age; and Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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. 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. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 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. Second, while complications are not high in FFS, they may occur. 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. Plast Reconstr Surg Glob Open. Qual Life Res. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. 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. Read more. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. 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). Plast Reconstr Surg. 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. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). 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. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 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. Leigh JP, Tancredi D, Jerant A, et al. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 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. Furthermore, revisions may be indicated in some patients over time. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Facial Feminization Surgery: A Guide for the Transgendered Woman. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. Their credential as an MD/DO/NP/PA/MSW/PHD and signature on an essentially form WPATH conforming letter are not sufficient- they need to impress upon the medical reviewers that they are not simply approving your referral request, but are guiding your care as a treating provider, and that this surgery is part of your care plan. 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. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. 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. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Are there transgender advocacy groups? During Your FFS Procedure How long it takes: This depends on what you are having done. 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 . 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]. 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). Choose from multiple implant types and sizes. 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. An estimated 10 patients (25.0%), all with private insurance, underwent an extended approval process requiring multi-level appeals and denial overturn after IMR and frequently, state intervention. 2016. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Error bars denote standard error. Dr. Freet accepts both insurance and Medicare. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Every insurance company is "difficult" to work with. Facial feminization surgery: the forehead. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 2018. 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. 5. These delicate procedures change the male facial patterns to a softer, feminine appearance. 15. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Bariatric Surgery. 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. Co-insurance past that? Dr. Charles Shih. One of the major issues among surgeons and patients with regard to insurance coverage for FFS is the lack of understanding of the process as coverage for gender healthcare is highly variable depending on state law and plan variabilities (Table 3). $8995. 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. 6. Patients were stratified into 3 groups by authorization process. He has been performing gender surgery since 2005. 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. 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. Your message has been successfully sent to your colleague. 8. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. 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. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. 2018; 153:609616. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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.
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