Out-of-pocket costs for FFS. . Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. https://links.lww.com/PRSGO/B648.). However, this has been a persuasive strategy in some cases. 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. Try your local trans advocacy groups, LGBTI legal services, support group, etc. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Your scars may take up to a year to heal. Our team will help you set up a MyChart account where you will have the ability to fill this out online. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 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. *. All rights reserved. These delicate procedures change the male facial patterns to a softer, feminine appearance. 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. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. 7. Simplifying facial feminization surgery using virtual modeling on the female skull. Plast Reconstr Surg. 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. 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 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. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 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. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. 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. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. https://links.lww.com/PRSGO/B647.). 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. Each patient is different and your expectations and desired results will be discussed fully in your consultation. 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.). Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. LGBT legal service projects? 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.) This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. 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. 3. 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Arch Intern Med. Available at: 9. 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. 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. Read more on our Insurance and Finance page. Error bars denote standard error. When it comes to facial feminization there is no substitute for experience. 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. 2010; 170:17281734. Received for publication February 2, 2021; accepted February 27, 2021. They submit their own information, information about the procedure being performed, and information about you. Any reimbursement from the insurance company (if any) would be paid directly to the patient. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. 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. Submission and review of initial authorization request (1 month); 2. Jess Ting - Plastic and Reconstructive Surgery | Mount Sinai - New York Home Profiles Mount Sinai Doctors Video Visit Available Accepting New Patients Jess Ting, MD Plastic and Reconstructive Surgery 4.6 Star s | 32 Responses CTMS 212-870-8270 View location details Book an Appointment About Me Clinical Focus Video Education & Certifications Awards Doximity. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. If performed all at once, FFS usually takes between 4- 8 hours. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. 13. Read more. Days, a 50-year-old Berkeley resident, had just returned from a month-long trip to Spain in February, where she underwent a procedure known as facial feminization surgery, or FFS. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Days, whose birth name was Douglas, came out as transgender in January, 2015. 2016; 137:438448. 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. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Schedule surgery 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*,. For more information, please refer to our Privacy Policy. 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. Two letters from mental health providers. Please refer to theCare Credit websitefor further details. She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. 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. Price (USD) Forehead Recontouring. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial 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. Plast Reconstr Surg. 2018 Physician Compensation Report. Please enable scripts and reload this page. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. Read more about our Clinics Finance and Insurance Policy here. Capitn L, Simon D, Kaye K, et al. If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. 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. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. 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 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. An estimated 90% of all patient consults were approved for FFS under insurance. 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. School-Based Dental Sealants; Licensed Rhode Island Dentists. 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). insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Get a bossy friend to make phone calls with you while you are dealing with the process. Physician wages across specialties: informing the physician reimbursement debate. Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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. 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. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Ask them how many FFS surgeries they perform within a year. Estimated costs of obtaining insurance approval for FFS (B). Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. 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 analysis was done by identifying individual steps involved in the insurance process (Fig. (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. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. $4985. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. 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. 3. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . 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. 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. 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. Both of these methods are. 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. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 1. ENQUIRE NOW. 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. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Submission and review of IMR (1 month).
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