Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Your message has been successfully sent to your colleague. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . 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. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Plast Reconstr Surg. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Transgender women may choose FFS as part of their male-to-female transition process. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Look here for licensed dentists practicing in the state. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Choose from multiple implant types and sizes. 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. information about insurance coverage: video.transcendlegal.org 2. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. However, this is starting to change. Everyone who is able to fight through it cracks the door open a little wider for the next person. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 8. Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System 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. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Dr. Freet accepts both insurance and Medicare. Temporal trends in gender-affirming surgery among transgender patients in the United States. 13. Requested CPT codes are detailed in Supplemental Digital Content 1. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Facial Feminization Surgery: What Is FFS, Hairline - Cleveland Clinic Dr. Thomas Satterwhite Please note that before you can schedule . Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. How NOT To Choose Your Facial Feminization Surgeon One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. 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. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. . Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Surgery referral assessment requirements | Gender Affirming Health Program Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Facial Feminization Surgery: What You Should Know - Healthline $4985. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Best FFS Surgeons: What to Know and Where to Go Facialteam Brow Lift. 12. 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. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. How Much Does Facial Feminization Surgery Cost? | RealSelf Each patient is different and your expectations and desired results will be discussed fully in your consultation. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Simplifying facial feminization surgery using virtual modeling on the female skull. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Padula WV, Heru S, Campbell JD. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Average months spent from initial facial feminization consultation to final insurance authorization decision. Facial Feminization Surgery (FFS) in Thailand - MyMediTravel 3). Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. 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. ENQUIRE NOW. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. You may be trying to access this site from a secured browser on the server. This guide is 201 level, geared towards those who find themselves covered with an ACA exchange plan or private insurance, as Medicaid processes are much more state specific. 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. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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. Submission and review of initial authorization request (1 month); 2. *, Time and cost of the insurance approval process for FFS. Thus, coverage significantly increases accessibility. The Case For Facial Feminization Surgery - BuzzFeed News 2. 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. Facial Feminization Surgery Before & After Pictures - RealSelf 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. 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. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Policy Issued By: Anthem. 6. Bottom Surgery: Cost, Recovery, Procedure Details, and More - Healthline By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 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. 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. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. FFS is a cost-effective intervention that needs to be covered by insurance policies. A surgeon who takes your insurance, hopefully in-network or willing to do the legwork of a single case agreement, with whom you are ready to move forward in planning surgery. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. 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). Gender-Affirmation Surgery | Transgender Surgery | The University of 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. 15. 2018; 80:198204. Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY 10. 2015; 136:560e561e. 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. How soon can I book a surgery date? Gender Affirmation Atlanta GA | Facial Feminization Alpharetta Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Policy Title: Gender Affirming Surgery. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Dr. Andrew Kleinberger. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). 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. Read this first. 2). 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. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna As with any surgical procedure, there are risks associated with FFS. 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 (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. You should be able to have easy access to this document through your insurance provider. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Please refer to theCare Credit websitefor further details. For example, there are now many hospitals across the . your express consent. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Plast Reconstr Surg. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Facial feminization surgery - Doctors & Departments - Mayo Clinic Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado Facial Feminization Surgery NYC | Board Certified Plastic Surgeon Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. 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. 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). Days, whose birth name was Douglas, came out as transgender in January, 2015. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. https://links.lww.com/PRSGO/B648.). This should be sent to you in written form, with the specific reason for the denial included. Facial Feminization Surgery (FSS) Houston and The Woodlands Wolters Kluwer Health, Inc. All rights reserved. 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. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Woolhandler S, Campbell T, Himmelstein DU. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Finding a Surgeon Integral to this whole process is the FGCS surgeon. 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. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). 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. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Although your FFS may not be covered by your insurance company its definitely worth doing the research. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Dr. 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. 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]. Get a bossy friend to make phone calls with you while you are dealing with the process. They accept most major insurances and work to help you get your surgery fully covered whenever possible. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Please try after some time. Facial feminization surgery - Mayo Clinic - Mayo Clinic - Mayo Clinic 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. 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. All rights reserved. Ask them how many FFS surgeries they perform within a year. Second, while complications are not high in FFS, they may occur. Finally, you should have an idea of your local resources. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 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. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Co-insurance past that? Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. JAMA Surg. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Additionally, planning and recovering from any trans surgery is hard! Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Surgical techniques and analysis of results. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 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. 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 From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS.