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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Patients who are definitively denied (Group C) may then exit their employer-based plan and switch to a plan under California jurisdiction on the health insurance exchange. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Research that Matters. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Ousterhout DK. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. 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. 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. 1. 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. may email you for journal alerts and information, but is committed Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. 2). In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 2020 Deschamps-braly clinic. 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. Arch Intern Med. Facial feminization surgery: the forehead. 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. Surgical techniques and analysis of results. This process will be long and draining, but it is worth it. However, this is starting to change. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Costs of health care administration in the United States and Canada. 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. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Plast Reconstr Surg. 3). This should be sent to you in written form, with the specific reason for the denial included. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. For more information, please refer to our Privacy Policy. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. 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. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. All rights reserved. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. 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. San Francisco, CA 94108. Available at: 9. Do you have access to out-of-network providers or in-network only. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. 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*,. Plast Reconstr Surg. Brow Lift. Please try after some time. Please try again soon. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. https://links.lww.com/PRSGO/B648.). 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. Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. 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 You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Upon denial, an IMR is requested directly from the insurance plan. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). 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. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Read on to find out why you might pay more or less, and whether the cost is really worth it. 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. . 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 delicate procedures change the male facial patterns to a softer, feminine appearance. 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 *, Time and cost of the insurance approval process for FFS. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. TransHealthCare.org uses cookies and other tracking technologies to improve your browsing experience on our website, to analyze our website traffic, and to understand where our visitors are coming from. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). 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. We hope our in-person consultation will answer all of your questions, provide your sense of confidence and also further your excitement of the path you are on. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). Thus, coverage significantly increases accessibility. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 15. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. After a person pays the deductible, Medicare pays 80% of the allowable costs . The report of the 2015 U.S. transgender survey. 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. 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? In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 12. 14. Plastic and Cosmetic Surgery. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Modeling performed by Padula and colleagues for employer-based insurance plans in Massachusetts indicated that, over the course of 5 years, coverage for transition-related services would lead to societal costs of $0.016 per month per member.3 The authors concluded that the relatively low societal cost, combined with the increase in quality-adjusted life years for transgender patients, supported coverage of transition-related services in employer-based plans. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 2018 Physician Compensation Report. 2. Have your facial features compromised your safety, making you a target for harassment and violence? 13. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. 3). In addition, many of them don't take 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. 2019; 144:11591168. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). To access this service, refer to the process below: Fill out and return the Service Inquiry Form. FFS is a cost-effective intervention that needs to be covered by insurance policies. 2016; 31:394401. 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. Finally, you should have an idea of your local resources. Woolhandler S, Campbell T, Himmelstein DU. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . 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. Please enable scripts and reload this page. 6. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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? Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 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). 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. Read more. Some error has occurred while processing your request. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 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. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Read more on our Insurance and Finance page. 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. Bariatric Surgery. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. While facial feminization surgery has many potential benefits, the decision to proceed . Co-insurance past that? As an example, the typical timeline for our Group B and C patients is as follows: 1. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. 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.) to maintaining your privacy and will not share your personal information without 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. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. 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. 2018. 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. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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.
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