He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. If it is substantial, they should name their years of experience working with transgender patients. Read this first. This is called facial feminization surgery. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 2018; 153:609616. 2003; 349:768775. 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. 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. For example, there are now many hospitals across the . There are a few limitations in this study that deserve mention. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. We have a dedicated Insurance Advocacy Team that handles the entire process of insurance approval for patients; we send all your documents to your insurance providers and work with them to try and secure coverage to the fullest extent. $8995. Submission and review of initial authorization request (1 month); 2. 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. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 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. https://links.lww.com/PRSGO/B647.). Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. James S, Herman J, Rankin S, et al. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. 6. Requires supporting documentation that indicates specific type of FFS procedures requested. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. 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. We can't guarantee insurance coverage but we can guarantee to try our hardest! 8. 2020; 8:e2618. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. What's your out of pocket max? 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. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. The benefits of such coverage far exceed the insignificant costs. 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. Patients were stratified into 3 groups by authorization process. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. *, Time and cost of the insurance approval process for FFS. 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 In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. 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. Dr. 2). 13. And some health insurance plans do cover the costs associated with facial feminization surgery procedures, so we recommend contacting your insurance provider to find out what is and is not covered under your current plan. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. According to the Philadelphia Center for Transgender 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. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Upon denial, an IMR is requested directly from the insurance plan. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Until then, CCTS will continue to require all patients using insurance for . In the standard approval process (Group A), patients were under both public and certain private insurance plans (39% of all privately insured patients in the cohort). We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. This is their communication with the insurance company verifying that the procedure is covered. 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). Bariatric Surgery. Wolters Kluwer Health, Inc. All rights reserved. Plast Reconstr Surg. your express consent. $8995. 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. Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist). Price (USD) Forehead Recontouring. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). 2019; 144:11591168. 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. Brow Lift. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . 1. 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. However, this is starting to change. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. may email you for journal alerts and information, but is committed 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. Braun TL, Braun JL, Hernandez C, et al. Additionally, planning and recovering from any trans surgery is hard! 2018; 319:691697. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 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). Second, while complications are not high in FFS, they may occur. 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. A total of 36 patients (90.0%) have been approved by insurance. They submit their own information, information about the procedure being performed, and information about you. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 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. Have your facial features compromised your safety, making you a target for harassment and violence? 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. 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. KP FFS Surgeons. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. After a person pays the deductible, Medicare pays 80% of the allowable costs . I don't philosophically agree with this. Hoang H, Bertrand AA, Hu AC, et al. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . 2016; 137:438448. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. 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. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. 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. From the cohort, 3 subgroups were delineated. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). 3). Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. https://links.lww.com/PRSGO/B648.). According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . Total Staff: 34. During Your FFS Procedure How long it takes: This depends on what you are having done. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 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. The United States . 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. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 2). Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. 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. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 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. Submission and review of IMR (1 month). 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. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? Prior to meeting with the social worker, patients should complete this assessment document. Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. 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. 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. 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. 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. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. Days, whose birth name was Douglas, came out as transgender in January, 2015. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 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.