insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Top facial feminization surgeons will typically undertake 2-3 facial full feminization procedures a week, this equates to at least 100 or more a year. Please refer to theCare Credit websitefor further details. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Want to use our data? 3). Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 2016. 2003; 349:768775. 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. Total Staff: 34. In contrast to Group A, patients who required significant efforts in the form of multi-level appeals, peer-to-peer reviews, and IMRs were designated Groups B and C, depending on ultimate approval versus denial as the outcomes, respectively. 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%). 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. 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.) This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. The analysis was done by identifying individual steps involved in the insurance process (Fig. Body-contouring. The doctor said very encouraging. The administrator hourly compensation set at our institution was used for the cost analysis. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Please read a few important elements consider when booking. Leigh JP, Tancredi D, Jerant A, et al. 2010; 19:10191024. 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. 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. 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. Every state is different so start with Google and reach out to these services in your state, theyre here for you! 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. 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. Submission and review of initial authorization request (1 month); 2. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. 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*,. Your message has been successfully sent to your colleague. Furthermore, revisions may be indicated in some patients over time. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Available at: 2. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 6. 4. 13. 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. Dr. Andrew Kleinberger. 2014; 134:609619. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 7. $4985. Patients were stratified into 3 groups by authorization process. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 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. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. What's your out of pocket max? Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. No. Get a bossy friend to make phone calls with you while you are dealing with the process. Facial Feminization Surgery: A Guide for the Transgendered Woman. Among the 26 patients (65.0%) who underwent the standard approval process, 13 patients had Medi-Cal, 4 patients had Medicare, and 9 patients had private insurance. As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. 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. your express consent. Woolhandler S, Campbell T, Himmelstein DU. Until then, CCTS will continue to require all patients using insurance for . Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. KP FFS Surgeons. 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. Tate, who has been with Starbucks for 15 years and now manages a store in Austin, Texas, is one of a growing number of Starbucks partners who have used the company's leading-edge benefits for transgender partners. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 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. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. A letter from your primary care provider or whoever prescribes your hormones. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. 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. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Please note that before you can schedule . Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. information about insurance coverage: video.transcendlegal.org 2. Plast Reconstr Surg Glob Open. See all insurance information. Some error has occurred while processing your request. Plast Reconstr Surg. 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. 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. 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. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Finally, you should have an idea of your local resources. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Do you have out of network benefits, or are you limited to providers in the network? Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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. 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. James S, Herman J, Rankin S, et al. 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. 2019; 144:11591168. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Received for publication February 2, 2021; accepted February 27, 2021. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Privacy Policy (Updated December 15, 2022). Error bars denote standard error. Prior to meeting with the social worker, patients should complete this assessment document. FFS is a cost-effective intervention that needs to be covered by insurance policies. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Plast Reconstr Surg. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 2020 Deschamps-braly clinic. This is also the point at which general 201 level guidance ceases to be useful. You may be trying to access this site from a secured browser on the server. 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. Ainsworth TA, Spiegel JH. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Look here for licensed dentists practicing in the state. Average months spent from initial facial feminization consultation to final insurance authorization decision. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Wolters Kluwer Health Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Complete New Patient Questionnaire. You will be asked to complete an intake questionnaire before your consultation. 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. The benefits of such coverage far exceed the insignificant costs. Co-insurance past that? Dr. Thomas Satterwhite They accept most major insurances and work to help you get your surgery fully covered whenever possible. In fact, he is one of the most experienced gender surgeons in the world. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. Gender-Affirming Surgery: Original Article. 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. Second, while complications are not high in FFS, they may occur. 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. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. 11. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. 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 addition, many of them don't take insurance. 1. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. However, this has been a persuasive strategy in some cases. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Facial feminization surgery (FFS): The permanent . Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Hoang H, Bertrand AA, Hu AC, et al. 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 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. However, some insurers are beginning to cover FFS from select surgeons. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 2). Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 2018; 319:691697. This is their communication with the insurance company verifying that the procedure is covered. 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 (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. Patients seeking services from our practice are personally and fully responsible for payment of all fees and costs related to your FFS surgery and medical care. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. The generalizability of the findings presented here is limited by state laws. 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. 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. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. The United States . If they are a member of WPATH or other applicable professional associations, they should name that. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. All rights reserved. These delicate procedures change the male facial patterns to a softer, feminine appearance. Submission and review of second level, patient-initiated appeal (1 month); 4. School-Based Dental Sealants; Licensed Rhode Island Dentists. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. 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. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. In addition to administrative time, multi-level appeals required time from the attending craniofacial surgeon for peer-to-peer reviews, writing appeal letters, and patient counseling over the 6-month period, in total averaging 3.6 0.5 hours per patient. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). *, Time and cost of the insurance approval process for FFS. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. 2. Submission and review of IMR (1 month). This could be a good time to join (or form!) Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. 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. Gray R, Nguyen K, Lee JC, et al. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 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. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure.

James Whitham Trackday Photos, Difference Between Non Voluntary And Involuntary Euthanasia, Articles F