Gender-Affirming Surgery: Original Article. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 1. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. 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. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Only patients with insurance authorization decisions were included in this study (n = 40). Your insurance might have a requirement about length of time in care with them, or degree level. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Error bars denote standard error. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Your message has been successfully sent to your colleague. However, this is starting to change. 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. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. JAMA. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Male-to-female (MTF) facial feminization. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 2010; 19:10191024. 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. 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. 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. Group A (standard approval) included patients who were approved after undergoing a standard authorization process, such as those with Medi-Cal, Medicare, and private insurance. Want to use our data? Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . 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. 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. San Francisco, CA 94108. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. 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. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. Although your FFS may not be covered by your insurance company its definitely worth doing the research. 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. When it comes to facial feminization there is no substitute for experience. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Ainsworth TA, Spiegel JH. surgical techniques and analysis of results. Requested CPT codes are detailed in Supplemental Digital Content 1. What's your out of pocket max? Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 2010; 170:17281734. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. 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. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Wolters Kluwer Health, Inc. All rights reserved. Dr. Thomas Satterwhite Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). In fact, he is one of the most experienced gender surgeons in the world. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 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 standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Days, whose birth name was Douglas, came out as transgender in January, 2015. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 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. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. 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. 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. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. ENQUIRE NOW. If performed all at once, FFS usually takes between 4- 8 hours. Temporal trends in gender-affirming surgery among transgender patients in the United States. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. Please enable scripts and reload this page. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 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. Location: Bangkok, Thailand. 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. 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. 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. A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. 1. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. *, Time and cost of the insurance approval process for FFS. Body-contouring. KP FFS Surgeons. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. Otherwise, your deposit will be applied towards your surgical balance. 2). During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. The format for an appeals process and regulations/law/policy to cite within it vary widely depending on the mix of state and local regulations that apply to your specific plan. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Facial feminization surgery can be covered by health insurance in some instances. 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%). 3). They submit their own information, information about the procedure being performed, and information about you. Our current work highlights the high likelihood of success in FFS coverage under insurance in California, but also details the challenges that plastic surgeons and plastic surgery practices incur for coverage to occur. 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. The United States . Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. Furthermore, revisions may be indicated in some patients over time. 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. 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. 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.
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