Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Upon denial, an IMR is requested directly from the insurance plan. Please try again soon. 3. Finally, you should have an idea of your local resources. Read this first. 2016; 137:438448. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. For more information, please refer to our Privacy Policy. Look here for licensed dentists practicing in the state. Each patient is different and your expectations and desired results will be discussed fully in your consultation. 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. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Gray R, Nguyen K, Lee JC, et al. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 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? Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. 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. Additionally, planning and recovering from any trans surgery is hard! Facial feminization surgery can be covered by health insurance in some instances. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. 1). 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. Dr. Facque joined the Gender Confirmation Centers team in September 2020 as a full-time Associate Surgeon specializing in Facial Gender Confirmation Surgery, Top Surgery and Body Contouring. 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. 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. When it comes to facial feminization there is no substitute for experience. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Schedule surgery On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. 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. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. There are 301 level topics not covered here- going out of network to an office who will only give you CPT codes performed, getting a network exception to go to a provider with skills not available among in-network surgeons, etc. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. 15. Want to use our data? Requested CPT codes are detailed in Supplemental Digital Content 1. 3. 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. Please enable scripts and reload this page. 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. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Read more on our Insurance and Finance page. Furthermore, revisions may be indicated in some patients over time. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. 2018. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Policy Title: Gender Affirming Surgery. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. This is called facial feminization surgery. 2. 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. 2019; 144:11591168. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 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. Until then, CCTS will continue to require all patients using insurance for . Dr. Now you will be denied! Everyone who is able to fight through it cracks the door open a little wider for the next person. 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. Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. Wolters Kluwer Health 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. If it is substantial, they should name their years of experience working with transgender patients. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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. 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 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. 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. Submission and review of initial authorization request (1 month); 2. 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. Support groups? Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Please read a few important elements consider when booking. 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. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. 2014; 134:609619. 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. 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. 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. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Read more. School-Based Dental Sealants; Licensed Rhode Island Dentists. It's an attempt to make the face as attractive as possible for as long as it lasts. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. If they are a member of WPATH or other applicable professional associations, they should name that. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). These procedures may include: Tummy tuck, called abdominoplasty. 3). Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Days, whose birth name was Douglas, came out as transgender in January, 2015. 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. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 1. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Brow Lift. 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). Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. As with any surgical procedure, there are risks associated with FFS. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. $8995. 2018; 153:609616. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. An estimated 90% of all patient consults were approved for FFS under insurance. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. $4985. 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 . 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. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. 2018; 80:198204. Two letters from mental health providers. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. Tseng P, Kaplan RS, Richman BD, et al. Plast Reconstr Surg Glob Open. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. In addition, many of them don't take insurance. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? You will be asked to complete an intake questionnaire before your consultation. 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. 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. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). ENQUIRE NOW. . Regardless, I recommend that you fight everything out in the preauthorization/pre service review process, and not after you have already paid and might be left holding the bill. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 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. Post-surgery garments; Medical tests and x-rays; When choosing a board-certified plastic surgeon for facial feminization surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. If performed all at once, FFS usually takes between 4- 8 hours. Only if your insurance provider authorizes a Letter of Agreement. Conveniently Located to Serve Chicago and Illinois. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Available at: 9. 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. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. This is the point at which you will likely need legal support. The structure of this system sucks, but it's the one in which you find yourself and it is your responsibility to make it work for you. 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. Finding a Surgeon Integral to this whole process is the FGCS surgeon. While facial feminization surgery has many potential benefits, the decision to proceed . No. Facial feminization surgery (FFS): The permanent . 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. 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. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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*,. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. 6. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Location: Bangkok, Thailand. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 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. Submission and review of physician-initiated appeal (1 month); 3. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. your express consent. As an example, the typical timeline for our Group B and C patients is as follows: 1. This process will be long and draining, but it is worth it. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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. surgical techniques and analysis of results. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Bariatric Surgery. The benefits of such coverage far exceed the insignificant costs. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. Complete New Patient Questionnaire. 10. 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).