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. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. 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. Wolters Kluwer Health, Inc. All rights reserved. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 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. your express consent. 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. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. Do you have access to out-of-network providers or in-network only. Ask them how many FFS surgeries they perform within a year. 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. Insurance and facial feminization surgery - 2pass Clinic Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Furthermore, revisions may be indicated in some patients over time. Feminizing surgery - Mayo Clinic FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Facial Feminization Surgery: What You Should Know - Healthline If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Upon denial, an IMR is requested directly from the insurance plan. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Ousterhout DK. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Canner JK, Harfouch O, Kodadek LM, et al. to maintaining your privacy and will not share your personal information without 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. 3. LGBT legal service projects? 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. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 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. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. Requires supporting documentation that indicates specific type of FFS procedures requested. 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. 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. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Plast Reconstr Surg. 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. 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. The objective is to soften the facial . *. 6. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 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. Ask to speak to people's supervisors. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive Facial Feminization Surgery (FFS) in Thailand - MyMediTravel 2010; 170:17281734. How NOT To Choose Your Facial Feminization Surgeon Surgical techniques and analysis of results. Are there transgender advocacy groups? In addition, many of them don't take insurance. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Price (USD) Forehead Recontouring. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Every insurance company is "difficult" to work with. Woolhandler S, Campbell T, Himmelstein DU. Start with ensuring that you have an in-depth understanding of your insurance benefits. If performed all at once, FFS usually takes between 4- 8 hours. 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. 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 Does Medicare Cover Facial Feminization Surgery? Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Read more on our Insurance and Finance page. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Facial Feminization Surgery | Michigan Medicine - U of M Health 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 . Transgender health care coverage | HealthCare.gov Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. FFS: money and choosing a surgeon : r/Transgender_Surgeries 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. Does Medicare cover gender reassignment surgery? - Medical News Today FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. 4. 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. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. A letter from your primary care provider or whoever prescribes your hormones. Facial Feminization Surgery - Need FFS? Find the Best FFS Surgeons This could be a good time to join (or form!) Some of the procedures included in facial feminization surgery are: Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. They submit their own information, information about the procedure being performed, and information about you. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Finding a Surgeon Integral to this whole process is the FGCS surgeon. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. 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. Facial Feminization Surgery Timeline - Gender Confirmation From the cohort, 3 subgroups were delineated. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). They accept most major insurances and work to help you get your surgery fully covered whenever possible. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 1. Facial Feminization Surgery: FFS Surgery in Thailand Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. The analysis was done by identifying individual steps involved in the insurance process (Fig. 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). 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. 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. Your insurance might have a requirement about length of time in care with them, or degree level. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Gender-Affirming Surgery Information - East Bay Submission and review of initial authorization request (1 month); 2. 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. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures, including Top Surgery, Phalloplasty, Vaginoplasty and Facial Feminization Surgery. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Integral to this whole process is the FGCS surgeon. 2016; 31:394401. Insurance Requirements for Gender Confirmation Surgery - Verywell Health In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. . 14. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine Third, full-face, one-stage FFS is a highly time-consuming surgery due to the multiple anatomical areas addressed at once (averaging 8.5 hours in the senior authors experience). In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Padula WV, Heru S, Campbell JD. Dr. Javad Sajan, MD is a Cosmetic, Plastic and Reconstructive Surgeon in Seattle who specializes in Gender-Affirming Surgery including Top Surgery, Breast Augmentation, Body Sculpting and Facial Feminization. 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 . Patients were stratified into 3 groups by authorization process. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 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. Months required for definitive insurance authorization decisions for FFS. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. 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. 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. Notes. 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. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Please refer to theCare Credit websitefor further details. 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. Bariatric Surgery. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons J Gen Intern Med. 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. 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. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. may email you for journal alerts and information, but is committed Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Prior to meeting with the social worker, patients should complete this assessment document. ENQUIRE NOW. 2018 Physician Compensation Report. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Facial Feminisation Surgery | Nuffield Health Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 2016; 137:438448. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. For Bay Area trans women, facial feminization surgery helps complete All rights reserved. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. The blossoming of academic medical centers offering transgender surgical care also means that more well respected surgeons, with appropriate craniofacial and maxilliofacial reconstructive training, are able to do procedures through insurance. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 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. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 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. 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. The benefits of such coverage far exceed the insignificant costs. Find a Surgeon for Gender Affirming Surgery - TransHealthCare Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Facial Feminization Surgery (FFS) in Mexico - MyMediTravel The Ins & Outs of Traveling Abroad for FFS Surgery The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. The administrator hourly compensation set at our institution was used for the cost analysis. Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. Two letters from mental health providers. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. 13. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. These procedures may include: Tummy tuck, called abdominoplasty. Facial feminization surgery: the forehead. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). An estimated 90% of all patient consults were approved for FFS under insurance. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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 can be covered by health insurance in some instances. 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. Do you have out of network benefits, or are you limited to providers in the network? Available at: 2. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Received for publication February 2, 2021; accepted February 27, 2021. 7. The Group C authorization process, which resulted in denial of services, consumed a 9-fold higher amount of time (P < 0.001) and 26-fold higher cost (P < 0.001) when compared with Group A (Fig. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). The addition of multi-level appeals in Groups B and C increased the total time for a definitive decision (7.0 and 5.1 months, respectively) and required both surgeon and administrative time to navigate the process (10.8 and 12.0 hours, respectively). Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Although your FFS may not be covered by your insurance company its definitely worth doing the research. 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. 3). 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. 2). Research that Matters. 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. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Otherwise, your deposit will be applied towards your surgical balance. In fact, he is one of the most experienced gender surgeons in the world. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Paying for Transgender Surgeries - Investopedia Plast Reconstr Surg. 2. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. Rhinoplasty. Policy Issued By: Anthem. What's your out of pocket max? Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. https://links.lww.com/PRSGO/B648.) Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 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.
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