Facial Feminization Surgery (FFS) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. 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. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Dr. Javad Sajan, MD is a Cosmetic, Plastic and Reconstructive Surgeon in Seattle who specializes in Gender-Affirming Surgery including Top Surgery, Breast Augmentation, Body Sculpting and Facial Feminization. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 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? 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. When it comes to facial feminization there is no substitute for experience. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. $4985. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Complete New Patient Questionnaire. Finally, you should have an idea of your local resources. 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. Qual Life Res. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. KP FFS Surgeons. Price (USD) Forehead Recontouring. Although your FFS may not be covered by your insurance company its definitely worth doing the research. 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. Support groups? The administrator hourly compensation set at our institution was used for the cost analysis. School-Based Dental Sealants; Licensed Rhode Island Dentists. I don't philosophically agree with this. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Doximity. Bariatric Surgery. 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. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. 3). Read this first. Dr. Thomas Satterwhite Generally, one provider should have a doctoral level degree (PhD, DSW, Psychiatrist MD) and the other can have a masters level degree (MSW, MHC, etc.) This means that the surgeon is either already in network with your insurance and is willing to send a prior authorization, or has an office willing to do the legwork of doing a letter of agreement with your insurance. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. 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. Ask them how many FFS surgeries they perform within a year. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Ask to speak to people's supervisors. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Error bars denote standard error. 2). 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. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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*,. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Otherwise, your deposit will be applied towards your surgical balance. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. 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. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Wolters Kluwer Health, Inc. All rights reserved. An estimated 90% of all patient consults were approved for FFS under insurance. The analysis was done by identifying individual steps involved in the insurance process (Fig. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). As with any surgical procedure, there are risks associated with FFS. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 3). Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Only if your insurance provider authorizes a Letter of Agreement. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 2018; 80:198204. 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). 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.) Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 2016; 31:394401. Data is temporarily unavailable. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. https://links.lww.com/PRSGO/B648.). 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. Until then, CCTS will continue to require all patients using insurance for . Co-insurance past that? In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. 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. Facial Feminization Surgery: A Guide for the Transgendered Woman. Some of the procedures included in facial feminization surgery are: 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 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. 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. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 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. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Error bars denote standard error. Dr. Gurjala joined Align Surgical Associates in 2019, after five years of performing gender surgery, microsurgery, and general reconstructive and aesthetic surgery in the Kaiser Permanente healthcare network. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Get a bossy friend to make phone calls with you while you are dealing with the process. 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). James S, Herman J, Rankin S, et al. Procedures requested for facial feminization insurance authorization are detailed in Table 2. 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. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Thus, coverage significantly increases accessibility. 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. 3). The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Prior to meeting with the social worker, patients should complete this assessment document. If performed all at once, FFS usually takes between 4- 8 hours. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. I could go on about this, but I hate to further the expectation that you must be very mentally ill in order for the "extreme" treatment of FGCS to be warranted. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. 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. Average months spent from initial facial feminization consultation to final insurance authorization decision. J Gen Intern Med. Simplifying facial feminization surgery using virtual modeling on the female skull. 1. Submission and review of IMR (1 month). This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. 3. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. These delicate procedures change the male facial patterns to a softer, feminine appearance. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). 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. Capitn L, Simon D, Kaye K, et al. Your insurance might have a requirement about length of time in care with them, or degree level. You should be able to have easy access to this document through your insurance provider. LGBT legal service projects? We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. 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.). Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Jess Ting - Plastic and Reconstructive Surgery | Mount Sinai - New York Home Profiles Mount Sinai Doctors Video Visit Available Accepting New Patients Jess Ting, MD Plastic and Reconstructive Surgery 4.6 Star s | 32 Responses CTMS 212-870-8270 View location details Book an Appointment About Me Clinical Focus Video Education & Certifications Awards We have a dedicated Insurance Advocacy Team that handles the entire process of insurance approval for patients; we send all your documents to your insurance providers and work with them to try and secure coverage to the fullest extent. One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. Conveniently Located to Serve Chicago and Illinois. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. JAMA Surg. 6. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Facial feminization surgery can be covered by health insurance in some instances. 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. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 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. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. 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). From the cohort, 3 subgroups were delineated. Thus, coverage significantly increases accessibility. 7. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Both of these methods are. In addition, many of them don't take insurance. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. 2018; 319:691697. Facial feminization surgery: the forehead. 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. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. This is also the point at which general 201 level guidance ceases to be useful. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Plast Reconstr Surg Glob Open. Arch Intern Med. Gray R, Nguyen K, Lee JC, et al. See all insurance information. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. 1. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. 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. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. There are a few limitations in this study that deserve mention. If they are a member of WPATH or other applicable professional associations, they should name that. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Gender-Affirming Surgery: Original Article. Call 913-588-6200 to request a consultation. Patients were stratified into 3 groups by authorization process. 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). According to the Philadelphia Center for Transgender Surgery,. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. However, the cost can range from $1,847 to $62,000, depending on a few key factors. 8. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . (link is external) for CGSP. For more information, please refer to our Privacy Policy. A total of 36 patients (90.0%) have been approved by insurance. Facial feminization surgery: the forehead. Dr. Andrew Kleinberger. Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . ENQUIRE NOW. Location: Bangkok, Thailand. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Only patients with insurance authorization decisions were included in this study (n = 40). Please try again soon. Out-of-pocket costs for FFS. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Some error has occurred while processing your request. 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. 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. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. 2010; 170:17281734. 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. Plast Reconstr Surg. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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. 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. For example, there are now many hospitals across the . 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). I am working from the perspective that you are unable to pay in full and be reimbursed. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure.
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