Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . 3). 6. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. 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. Wolters Kluwer Health, Inc. All rights reserved. 2). Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. 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. Facial feminization surgery (FFS): The permanent . (link is external) for CGSP. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 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. 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. 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. 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. Two letters from mental health providers. 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. 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. 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. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Dr. Thomas Satterwhite Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 2014; 134:609619. She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. Do you have out of network benefits, or are you limited to providers in the network? Compared with the published literature, patients within Groups B and C are multi-fold greater than the reported standard estimates in the former study without even taking into account time and costs of post-surgical billing activities. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). 3). $4985. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. FGCS is a treatment for gender dysphoria related to the secondary sex characteristics in the face, not a treatment for anxiety caused by the experience of having gender dysphoria or being a transgender person in an unkind world. Now you will be denied! Location: Bangkok, Thailand. Your message has been successfully sent to your colleague. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. 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. 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. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Your scars may take up to a year to heal. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. 2019; 144:11591168. Some of the procedures included in facial feminization surgery are: 12. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? A letter from your primary care provider or whoever prescribes your hormones. Canner JK, Harfouch O, Kodadek LM, et al. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). A prior authorization is not a guarantee of payment, therefore, you should have funds available to cover all fees and costs related to your surgery should your request be denied. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. P < 0.05 was considered significant. The benefits of such coverage far exceed the insignificant costs. https://links.lww.com/PRSGO/B648.) Both of these methods are. 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. 1. 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. 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. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Post Surgery Recovery. It's an attempt to make the face as attractive as possible for as long as it lasts. This process will be long and draining, but it is worth it. However, California state law stipulates gender non-discrimination in health insurance, thus, Medi-Cal covers all procedures performed specifically for the purposes of gender affirmation. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Dr. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. 2015; 136:560e561e. 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. 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. 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 on to find out why you might pay more or less, and whether the cost is really worth it. 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Plast Reconstr Surg. 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 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. The generalizability of the findings presented here is limited by state laws. Facial Feminization Surgery (FFS) Preparation Guide. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. 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. 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. Complete New Patient Questionnaire. He has been performing gender surgery since 2005. 2020; 8:e2618. 11. 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. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. may email you for journal alerts and information, but is committed Submission and review of physician-initiated appeal (1 month); 3. Read more on our Insurance and Finance page. information about insurance coverage: video.transcendlegal.org 2. ENQUIRE NOW. 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. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. The work cannot be changed in any way or used commercially without permission from the journal. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Otherwise, your deposit will be applied towards your surgical balance. An estimated 90% of all patient consults were approved for FFS under insurance. Prior to meeting with the social worker, patients should complete this assessment document. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. This is called facial feminization surgery. Dr. Thomas Satterwhite Dr. Charles Shih. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 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 . Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Plastic surgery on the face. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. https://links.lww.com/PRSGO/B648.). 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 1. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. There are a few limitations in this study that deserve mention. Furthermore, revisions may be indicated in some patients over time. 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. 15. Some error has occurred while processing your request. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Thus, coverage significantly increases accessibility. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. $8995. Second, while complications are not high in FFS, they may occur. 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). Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Call 913-588-6200 to request a consultation. However, this has been a persuasive strategy in some cases. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. 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. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Wolters Kluwer Health Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 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. your express consent. 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. Support groups? Facial feminization surgery can be covered by health insurance in some instances. 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. 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. JAMA Surg. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. 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. Descriptive statistics were performed for demographic variables. Additionally, planning and recovering from any trans surgery is hard! Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Out-of-pocket costs for FFS. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. to maintaining your privacy and will not share your personal information without I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Submission and review of IMR (1 month). Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Plast Reconstr Surg Glob Open. KP FFS Surgeons. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 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. 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. Plast Reconstr Surg. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 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. Among the various gender-affirming procedures, facial feminization surgery (FFS) is arguably the most commonly denied surgery, as insurance companies often deem the involved procedures as cosmetic and not medically necessary. 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). This is their communication with the insurance company verifying that the procedure is covered. 2003; 349:768775. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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.) One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Submission and review of second level, patient-initiated appeal (1 month); 4. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Procedure. 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. Error bars denote standard error. 5. 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. Temporal trends in gender-affirming surgery among transgender patients in the United States. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. 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. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Requires supporting documentation that indicates specific type of FFS procedures requested. Read more about our Clinics Finance and Insurance Policy here. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 2018. Notes. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Ask to speak to people's supervisors. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Error bars denote standard error. 13. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. The analysis was done by identifying individual steps involved in the insurance process (Fig. While facial feminization surgery has many potential benefits, the decision to proceed . 2). 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). Dr. Andrew Kleinberger. 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. Everyone who is able to fight through it cracks the door open a little wider for the next person. School-Based Dental Sealants; Licensed Rhode Island Dentists. Plast Reconstr Surg. It involves plastic surgery techniques in which the jaw, chin, cheeks, forehead, nose, and areas surrounding the eyes, ears or lips are changed to create a more feminine appearance. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. Capitn L, Simon D, Kaye K, et al. 2. surgical techniques and analysis of results. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. A total of 36 patients (90.0%) have been approved by insurance. 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). 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. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. 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. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Please first read this resource for a general overview of insurance utilization for trans surgery. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Body-contouring. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Padula WV, Heru S, Campbell JD. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. See all insurance information. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. 2). This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Total Staff: 34. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Patients were stratified into 3 groups by authorization process. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Please enable scripts and reload this page. 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. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. 2010; 19:10191024. 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. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Available at: 2. If performed all at once, FFS usually takes between 4- 8 hours. Start with ensuring that you have an in-depth understanding of your insurance benefits. 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. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. 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%). Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 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.

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