ffs surgeons who take insurance
Transgender health care coverage | HealthCare.gov The work cannot be changed in any way or used commercially without permission from the journal. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 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]. An estimated 10 patients (25.0%), all with private insurance, underwent an extended approval process requiring multi-level appeals and denial overturn after IMR and frequently, state intervention. Temporal trends in gender-affirming surgery among transgender patients in the United States. School-Based Dental Sealants; Licensed Rhode Island Dentists. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). After a person pays the deductible, Medicare pays 80% of the allowable costs . Doximity. 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. Please first read this resource for a general overview of insurance utilization for trans surgery. Facial Feminization in Korea - Everything You Need to Know! Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Both of these methods are. Want to use our data? 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). 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. Every state is different so start with Google and reach out to these services in your state, theyre here for you! Months required for definitive insurance authorization decisions for FFS. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? A total of 36 patients (90.0%) have been approved by insurance. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 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. I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. No. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. 11. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. The concept and treatments were developed with transfeminine patients in mind in the 1980s, led by a San Francisco-based surgeon who devised measurements for a "normal" female appearance by surveying anthropological skeletal records. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. JAMA Surg. 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. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 2014; 134:609619. LGBT legal service projects? Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 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. 12. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Everyone who is able to fight through it cracks the door open a little wider for the next person. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 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. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. These procedures may include: Tummy tuck, called abdominoplasty. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 2018; 80:198204. 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Facial Feminization Surgery FFS Insurance Coverage As with any surgical procedure, there are risks associated with FFS. 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. Schedule surgery If performed all at once, FFS usually takes between 4- 8 hours. 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. P < 0.05 was considered significant. Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 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%). 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. Read this first. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. 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. Now you will be denied! This should be sent to you in written form, with the specific reason for the denial included. 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. Facial feminization surgery (FFS): The permanent . 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. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Gender-Affirmation Surgery | Transgender Surgery | The University of Facial Feminization Surgery (FSS) Houston and The Woodlands In addition, many of them don't take insurance. Dr. Satterwhite is a board-certified Plastic and Craniofacial Surgeon in San Francisco who is dedicated to offering the highest level of surgical care to the transgender community. 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. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. 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. Facial Feminization Surgery (FFS) Preparation Guide. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Available at: 9. 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. Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. 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. 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. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Integral to this whole process is the FGCS surgeon. Dr. Freet accepts both insurance and Medicare. 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. Otherwise, your deposit will be applied towards your surgical balance. 2010; 170:17281734. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Your scars may take up to a year to heal. Body-contouring. Some error has occurred while processing your request. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Health insurance might not cover surgical procedures considered cosmetic for the cisgender population people whose gender identity matches the one they were assigned at birth even though these procedures are . Physician wages across specialties: informing the physician reimbursement debate. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Doctors and nurses take good care. Wolters Kluwer Health Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. 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. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 2016; 137:438448. However, the cost can range from $1,847 to $62,000, depending on a few key factors. 2. He has been performing gender surgery since 2005. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. 1. 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. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Private insurances included health maintenance organizations and preferred provider organization. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Facial Feminization Surgery under Insurance: The University - LWW Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 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. Plast Reconstr Surg. 2018. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna (link is external) for CGSP. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. 2015; 136:560e561e. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net Facial Feminization Surgery: FFS Surgery in Thailand Using Insurance for Facial Gender Confirming Surgery or "FFS" Facial Feminization Surgery | Michigan Medicine - U of M Health These patients underwent a standard approval process no different from other reconstructive procedures (Group A). (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Look here for licensed dentists practicing in the state. Start with ensuring that you have an in-depth understanding of your insurance benefits. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. There are a few limitations in this study that deserve mention. 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. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. 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). 10. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. https://links.lww.com/PRSGO/B648.). Dr. KathleynBrandstetter. Wolters Kluwer Health, Inc. All rights reserved. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Facial feminization surgery: the forehead. 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). P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Only if your insurance provider authorizes a Letter of Agreement. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Second, while complications are not high in FFS, they may occur. Gender Affirmation Surgery - University of Utah Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. 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. We can't guarantee insurance coverage but we can guarantee to try our hardest! Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Facial feminization surgery: the forehead. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 2. JAMA. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 7. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. https://links.lww.com/PRSGO/B648.) Yet, a number of studies have demonstrated that FFS is not only associated with improvement in quality of life for transfeminine patients, but also, for some patients, the most important aspect of transition.47 Although significant barriers exist, an improvement in insurance coverage for FFS has occurred over time, albeit navigation of the process is both laborious and confusing. 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. surgical techniques and analysis of results. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Notes. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. Descriptive statistics were performed for demographic variables. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. *. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 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). We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Plast Reconstr Surg. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. When it comes to facial feminization there is no substitute for experience. Finally, you should have an idea of your local resources. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Ask them how many FFS surgeries they perform within a year. Starbucks offers expanded benefits for trans people 2). 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. HB2084 (2016) bans gender identity discrimination in health insurance and HB2405 (2022) bans categorical exclusions for gender-affirming care under any health plan, though the law does not . 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. If they are a member of WPATH or other applicable professional associations, they should name that. Paying for Transgender Surgeries - Investopedia 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. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. KP FFS Surgeons. 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.