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. This is the point at which you will likely need legal support. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Submission and review of second level, patient-initiated appeal (1 month); 4. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Dr. Thomas Satterwhite Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. to maintaining your privacy and will not share your personal information without *. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. 2018; 153:609616. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. Requires supporting documentation that indicates specific type of FFS procedures requested. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Submission and review of physician-initiated appeal (1 month); 3. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Months required for definitive insurance authorization decisions for FFS. 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. Quality of life of individuals with and without facial feminization surgery or gender reassignment 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. 2018 Physician Compensation Report. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Please first read this resource for a general overview of insurance utilization for trans surgery. 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. A total of 36 patients (90.0%) have been approved by insurance. KP FFS Surgeons. In fact, he is one of the most experienced gender surgeons in the world. Ann Plast Surg. 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. Available at: 2. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. You may be trying to access this site from a secured browser on the server. J Gen Intern Med. 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) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. A letter from your primary care provider or whoever prescribes your hormones. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. 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. 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.) $8995. 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. 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. We hope our in-person consultation will answer all of your questions, provide your sense of confidence and also further your excitement of the path you are on. 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. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 11. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. 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. 3). Call 913-588-6200 to request a consultation. We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. Want to use our data? 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. 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. Second, while complications are not high in FFS, they may occur. All rights reserved. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. 2). 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Dr. Thomas Satterwhite The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Research that Matters. Temporal trends in gender-affirming surgery among transgender patients in the United States. Complete New Patient Questionnaire. This process will be long and draining, but it is worth it. 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. 2. Plast Reconstr Surg. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." ENQUIRE NOW. 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. Integral to this whole process is the FGCS surgeon. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. However, the cost can range from $1,847 to $62,000, depending on a few key factors. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Read more about our Clinics Finance and Insurance Policy here. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. 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. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. 3. 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. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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. N Engl J Med. 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. Do you have a deductible to meet? Gender-Affirming Surgery: Original Article. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). Arch Intern Med. 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. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. 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. Please refer to theCare Credit websitefor further details. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. You will be asked to complete an intake questionnaire before your consultation. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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 . Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 2010; 170:17281734. 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 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. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. 2). document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Finding a Surgeon Integral to this whole process is the FGCS surgeon. 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*,. 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. 2003; 349:768775. 3. 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. While facial feminization surgery has many potential benefits, the decision to proceed . Submission and review of initial authorization request (1 month); 2. Price (USD) Forehead Recontouring. Only if your insurance provider authorizes a Letter of Agreement. Ask them how many FFS surgeries they perform within a year. Private insurances included health maintenance organizations and preferred provider organization. Submission and review of IMR (1 month). Dr. Andrew Kleinberger. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. The objective is to soften the facial . 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. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Your insurance might have a requirement about length of time in care with them, or degree level. Male-to-female (MTF) facial feminization. Try your local trans advocacy groups, LGBTI legal services, support group, etc. 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. Choose from multiple implant types and sizes. 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. Doctors and nurses take good care. We can't guarantee insurance coverage but we can guarantee to try our hardest! Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Leigh JP, Tancredi D, Jerant A, et al. 5. P < 0.05 was considered significant. https://links.lww.com/PRSGO/B648.) 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. your express consent. 2015; 136:560e561e. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Your scars may take up to a year to heal. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Brow Lift. Ousterhout DK. 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.
