He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. Padula WV, Heru S, Campbell JD. 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. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. You may be trying to access this site from a secured browser on the server. 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 Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. P < 0.05 was considered significant. may email you for journal alerts and information, but is committed 3). 1. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. 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. Though WPATH has released the new SOC, it will take insurance companies time to evolve. The work cannot be changed in any way or used commercially without permission from the journal. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. Physician wages across specialties: informing the physician reimbursement debate. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. 5. 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Do you have out of network benefits, or are you limited to providers in the network? 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). Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. 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. 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? ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Submission and review of IMR (1 month). Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Finally, you should have an idea of your local resources. Dr. Thomas Satterwhite 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) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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). 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. Every insurance company is "difficult" to work with. 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. 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Care Credit approval amounts can vary from person to person. 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. Dr. Freet accepts both insurance and Medicare. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. surgical techniques and analysis of results. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Ask to speak to people's supervisors. 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. While facial feminization surgery has many potential benefits, the decision to proceed . These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 2). 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. 2016; 137:438448. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 2015; 136:560e561e. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. 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. Requested CPT codes are detailed in Supplemental Digital Content 1. 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. Co-insurance past that? Upon denial, an IMR is requested directly from the insurance plan. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 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%). 2010; 170:17281734. 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. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). Please try after some time. Canner JK, Harfouch O, Kodadek LM, et al. Prior to meeting with the social worker, patients should complete this assessment document. Submission and review of second level, patient-initiated appeal (1 month); 4. However, this has been a persuasive strategy in some cases. 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). This is their communication with the insurance company verifying that the procedure is covered. 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). 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? Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. During Your FFS Procedure How long it takes: This depends on what you are having done. Support groups? We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Read more. According to the Philadelphia Center for Transgender Surgery,. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Ousterhout DK. 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. $4985. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Leigh JP, Tancredi D, Jerant A, et al. 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. 3. However, this is starting to change. Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. 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. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Procedure. San Francisco, CA 94108. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Each letter should state "this procedure is medically necessary treatment. With all letters, I advise providers to be as authoritative in their tone as possible, and to explicitly claim an expert status if appropriate. 2018; 319:691697. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). *, Time and cost of the insurance approval process for FFS. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Brow Lift. 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. information about insurance coverage: video.transcendlegal.org 2. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 1. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 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. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Error bars denote standard error. Ask them how many FFS surgeries they perform within a year. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). After a person pays the deductible, Medicare pays 80% of the allowable costs . Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. 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. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Your scars may take up to a year to heal. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. 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. 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. 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. Choose from multiple implant types and sizes. 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. 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. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. This should be sent to you in written form, with the specific reason for the denial included. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. This could be a good time to join (or form!) Call 913-588-6200 to request a consultation. Schedule surgery 4. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Wolters Kluwer Health, Inc. All rights reserved. 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. 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.