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Available at: 9. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). *. Gender-Affirming Surgery: Original Article. Facial Feminization Surgery: A Guide for the Transgendered Woman. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Policy Issued By: Anthem. Wolters Kluwer Health Submission and review of initial authorization request (1 month); 2. Brow Lift. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. 2). 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. Available at: 2. Some error has occurred while processing your request. Some of the procedures included in facial feminization surgery are: Transgender women may choose FFS as part of their male-to-female transition process. 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. 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 We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Are there transgender advocacy groups? Our team will help you set up a MyChart account where you will have the ability to fill this out online. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. 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. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. 1. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. N Engl J Med. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. He has been performing gender surgery since 2005. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 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. 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. A letter from your primary care provider or whoever prescribes your hormones. 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. 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 Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 3. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. 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. 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. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. From the cohort, 3 subgroups were delineated. Both of these methods are. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 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. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Additionally, planning and recovering from any trans surgery is hard! 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. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Every state is different so start with Google and reach out to these services in your state, theyre here for you! 2020 Deschamps-braly clinic. Error bars denote standard error. Plast Reconstr Surg Glob Open. 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. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Conveniently Located to Serve Chicago and Illinois. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. information about insurance coverage: video.transcendlegal.org 2. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Ainsworth TA, Spiegel JH. Otherwise, your deposit will be applied towards your surgical balance. 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%). 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. 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. Until then, CCTS will continue to require all patients using insurance for . Privacy Policy (Updated December 15, 2022). 4. Facial feminization surgery: the forehead. to maintaining your privacy and will not share your personal information without Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Months required for definitive insurance authorization decisions for FFS. 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. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 3. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 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. The United States . Do you have access to out-of-network providers or in-network only. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Facial feminization surgery: the forehead. 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. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. FFS is a cost-effective intervention that needs to be covered by insurance policies. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. 2018; 153:609616. For example, there are now many hospitals across the . Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 2018; 80:198204. 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. Start with ensuring that you have an in-depth understanding of your insurance benefits. This process will be long and draining, but it is worth it. (link is external) for CGSP. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. The benefits of such coverage far exceed the insignificant costs. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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. This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. 10. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. 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. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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. may email you for journal alerts and information, but is committed 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. One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. 1). Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. In addition, many of them don't take insurance. 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. Patients who are definitively denied (Group C) may then exit their employer-based plan and switch to a plan under California jurisdiction on the health insurance exchange. Ann Plast Surg. Thus, coverage significantly increases accessibility. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 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 . Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Submission and review of IMR (1 month). I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. 1. The report of the 2015 U.S. transgender survey. surgical techniques and analysis of results. 2016; 137:438448. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. You should be able to have easy access to this document through your insurance provider. 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. Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. 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. 2). Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. 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. 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. 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. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. 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. 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. 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. 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. 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. Co-insurance past that? Furthermore, revisions may be indicated in some patients over time. https://links.lww.com/PRSGO/B648.). 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. 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 Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Your insurance might have a requirement about length of time in care with them, or degree level. The time spent on the presurgical authorization process for Groups B and C translated to an over 20-fold increase in cost ($855.00 and $988.38, respectively) compared with Group A. Navigation of the insurance process for FFS is challenging and time-consuming; however, coverage is a reality in California provided that multi-level appeals are exhausted. 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. For patients anticipating insurance coverage for your surgery, we appreciate that you may wish to seek insurance reimbursement for the cost of some or all of your feminization procedures and have outlined some general guidelines below. $8995. 2015; 136:560e561e. I don't philosophically agree with this. 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Read this first. 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. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Days, whose birth name was Douglas, came out as transgender in January, 2015. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 2018. Finally, you should have an idea of your local resources. 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. No. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Plast Reconstr Surg. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. https://links.lww.com/PRSGO/B648.) Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Submission and review of second level, patient-initiated appeal (1 month); 4. 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. 11. 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. It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 As many professions say, past performance does not guarantee future results. However, the tide of change is beginning to roll in- often where Medicaid begins, private plans will be forced to follow, so the clear coverage in California and New York bodes well for everyone. Do you have out of network benefits, or are you limited to providers in the network? Plastic surgery on the face. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Private insurances included health maintenance organizations and preferred provider organization. Dr. Andrew Kleinberger. 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. 3). Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Only patients with insurance authorization decisions were included in this study (n = 40). 12. Patients were stratified into 3 groups by authorization process.

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