Brow Lift. 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. Your message has been successfully sent to your colleague. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . *. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. The doctor said very encouraging. 2015; 136:560e561e. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 5. Dr. Thomas Satterwhite The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. The blossoming of academic medical centers offering transgender surgical care also means that more well respected surgeons, with appropriate craniofacial and maxilliofacial reconstructive training, are able to do procedures through insurance. For more information, please refer to our Privacy Policy. 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. As an example, the typical timeline for our Group B and C patients is as follows: 1. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. 13. These delicate procedures change the male facial patterns to a softer, feminine appearance. Your insurance might have a requirement about length of time in care with them, or degree level. 2016. The generalizability of the findings presented here is limited by state laws. Gender-Affirming Surgery: Original Article. 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? The administrator hourly compensation set at our institution was used for the cost analysis. 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 standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Dr. Charles Shih. Surgical techniques and analysis of results. 8. 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 study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Hoang H, Bertrand AA, Hu AC, et al. These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. In fact, he is one of the most experienced gender surgeons in the world. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). 2018; 153:609616. 1. 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. FFS is a cost-effective intervention that needs to be covered by insurance policies. I tell everyone to plan for an initial denial- even if FGCS is covered in your plan clearly, its likely that portions of the procedure will be denied as cosmetic. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Read on to find out why you might pay more or less, and whether the cost is really worth it. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. 10. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Available at: 9. Ainsworth TA, Spiegel JH. 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. This is called facial feminization surgery. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 1. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Error bars denote standard error. 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. Policy Issued By: Anthem. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Total Staff: 34. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. $4985. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Additionally, planning and recovering from any trans surgery is hard! https://links.lww.com/PRSGO/B647.). It's an attempt to make the face as attractive as possible for as long as it lasts. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. . Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. your express consent. In addition, many of them don't take insurance. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Location: Bangkok, Thailand. 6. 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. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. However, the cost can range from $1,847 to $62,000, depending on a few key factors. 3). A total of 36 patients (90.0%) have been approved by insurance. Dr. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. Physician wages across specialties: informing the physician reimbursement debate. *, Time and cost of the insurance approval process for FFS. Everyone who is able to fight through it cracks the door open a little wider for the next person. 14. 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. 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. 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. Facial Feminization Surgery (FFS) Preparation Guide. Call 913-588-6200 to request a consultation. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Costs of health care administration in the United States and Canada. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. J Gen Intern Med. 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. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Second, while complications are not high in FFS, they may occur. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. 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. information about insurance coverage: video.transcendlegal.org 2. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Data is temporarily unavailable. However, this is starting to change. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Padula WV, Heru S, Campbell JD. Some of the procedures included in facial feminization surgery are: Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Integral to this whole process is the FGCS surgeon. 2014; 134:609619. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Historically, FFS hasn't been covered by health insurance or government healthcare. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Schedule surgery Are there transgender advocacy groups? Requires supporting documentation that indicates specific type of FFS procedures requested. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). The benefits of such coverage far exceed the insignificant costs. 1. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. There are a few limitations in this study that deserve mention. Plastic and Cosmetic 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. School-Based Dental Sealants; Licensed Rhode Island Dentists. Canner JK, Harfouch O, Kodadek LM, et al. 2016; 137:438448. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. Until then, CCTS will continue to require all patients using insurance for . The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Leigh JP, Tancredi D, Jerant A, et al. Get a bossy friend to make phone calls with you while you are dealing with the process. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? 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. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. 2010; 170:17281734. James S, Herman J, Rankin S, et al. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. 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. Some error has occurred while processing your request. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Every state is different so start with Google and reach out to these services in your state, theyre here for you! This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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. Patients seeking services from our practice are personally and fully responsible for payment of all fees and costs related to your FFS surgery and medical care. 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. Please refer to theCare Credit websitefor further details. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Try your local trans advocacy groups, LGBTI legal services, support group, etc. 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. 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. Plast Reconstr Surg. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. However, this has been a persuasive strategy in some cases. According to the Philadelphia Center for Transgender Surgery,. Furthermore, revisions may be indicated in some patients over time. 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. Read more on our Insurance and Finance page. 7. Every insurance company is "difficult" to work with. Gray R, Nguyen K, Lee JC, et al. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. Ousterhout DK. Dr. Andrew Kleinberger. In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. 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). 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 You should be able to have easy access to this document through your insurance provider. 4. In the standard approval process (Group A), patients were under both public and certain private insurance plans (39% of all privately insured patients in the cohort). 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. Estimated costs of obtaining insurance approval for FFS (B). The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Plast Reconstr Surg. As with any surgical procedure, there are risks associated with FFS. LGBT legal service projects? Submission and review of physician-initiated appeal (1 month); 3. Notes. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 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). KP FFS Surgeons. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. 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. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. 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. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. 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.