We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. What's your out of pocket max? He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. surgical techniques and analysis of results. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. 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. 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. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. The generalizability of the findings presented here is limited by state laws. Facial feminization surgery (FFS): The permanent . Facial feminization surgery: the forehead. Only patients with insurance authorization decisions were included in this study (n = 40). Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. I don't philosophically agree with this. 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. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. 2018; 319:691697. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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. 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. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. 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. Simplifying facial feminization surgery using virtual modeling on the female skull. Procedure. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. 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. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. I am working from the perspective that you are unable to pay in full and be reimbursed. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Leigh JP, Tancredi D, Jerant A, et al. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Read more on our Insurance and Finance page. Do you have out of network benefits, or are you limited to providers in the network? 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. This is their communication with the insurance company verifying that the procedure is covered. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 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. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. Costs of health care administration in the United States and Canada. This is called facial feminization surgery. 7. 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). The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. Padula WV, Heru S, Campbell JD. There are a few limitations in this study that deserve mention. The blossoming of academic medical centers offering transgender surgical care also means that more well respected surgeons, with appropriate craniofacial and maxilliofacial reconstructive training, are able to do procedures through insurance. Until then, CCTS will continue to require all patients using insurance for . Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Post Surgery Recovery. 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. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . For example, some may be reluctant to perform an osteotomy of the anterior table of the frontal bone for setback in an outpatient surgery center and, thus, default to a less aggressive method of frontal bone recontouring, which may be an undercorrection for certain patients. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Please try again soon. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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. may email you for journal alerts and information, but is committed Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. How soon can I book a surgery date? 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. Facial feminization surgery can be covered by health insurance in some instances. 2010; 19:10191024. Surgical techniques and analysis of results. 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.) 10. 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 Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 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.) FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. They submit their own information, information about the procedure being performed, and information about you. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. 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. Only if your insurance provider authorizes a Letter of Agreement. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. According to the Philadelphia Center for Transgender Surgery,. If they are a member of WPATH or other applicable professional associations, they should name that. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. your express consent. Submission and review of second level, patient-initiated appeal (1 month); 4. Get a bossy friend to make phone calls with you while you are dealing with the process. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). N Engl J Med. 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. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Both of these methods are. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. This is the point at which you will likely need legal support. Please enable scripts and reload this page. 11. Arch Intern Med. Some error has occurred while processing your request. Now you will be denied! Dr. KathleynBrandstetter. However, this is starting to change. 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. Second, while complications are not high in FFS, they may occur. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. 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. 2). Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. Otherwise, your deposit will be applied towards your surgical balance. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. 6. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Your insurance might have a requirement about length of time in care with them, or degree level. While facial feminization surgery has many potential benefits, the decision to proceed . . 5. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Error bars denote standard error. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. https://links.lww.com/PRSGO/B648.). Submission and review of initial authorization request (1 month); 2. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. 1). 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. 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. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). The objective is to soften the facial . Months required for definitive insurance authorization decisions for FFS. Average months spent from initial facial feminization consultation to final insurance authorization decision. In addition, many of them don't take insurance. 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 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). P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery.
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