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. 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. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. This is called facial feminization surgery. 2018. Insurance and facial feminization surgery - 2pass Clinic 3). 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.). Have your facial features compromised your safety, making you a target for harassment and violence? Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 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. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. JAMA Surg. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons 2. Look here for licensed dentists practicing in the state. Capitn L, Simon D, Kaye K, et al. 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 6. 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. Your scars may take up to a year to heal. 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. 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. I always advise people to try with the insurance they have before they switch to another plan. 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). Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. How Do I Pay For Facial Feminization Surgery? - drbastidas.com School-Based Dental Sealants; Licensed Rhode Island Dentists. 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. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Wolters Kluwer Health, Inc. All rights reserved. Arch Intern Med. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Facial Feminization in Korea - Everything You Need to Know! Read more on our Insurance and Finance page. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. 2016. 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. Research that Matters. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. https://links.lww.com/PRSGO/B648.). Two letters from mental health providers. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 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. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic Does Medicare cover gender reassignment surgery? - Medical News Today information about insurance coverage: video.transcendlegal.org 2. Read on to find out why you might pay more or less, and whether the cost is really worth it. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Although your FFS may not be covered by your insurance company its definitely worth doing the research. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Doximity. Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. According to the Philadelphia Center for Transgender Surgery,. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Policy Issued By: Anthem. Please refer to theCare Credit websitefor further details. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. The report of the 2015 U.S. transgender survey. 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). 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. The Ins & Outs of Traveling Abroad for FFS Surgery Find Dental Health Services: Department of Health - Rhode Island A letter from your primary care provider or whoever prescribes your hormones. 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. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. A total of 36 patients (90.0%) have been approved by insurance. Rhinoplasty. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Facial Feminization Surgery: Everything You Need to Know - Verywell Health 3. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Cost of Facial Feminization Surgery (FFS) and Insurance Information Read more about our Clinics Finance and Insurance Policy here. 2018; 80:198204. Months required for definitive insurance authorization decisions for FFS. Some error has occurred while processing your request. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Requested CPT codes are detailed in Supplemental Digital Content 1. Facial Feminization Surgery FFS Insurance Coverage 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. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. The Case For Facial Feminization Surgery - BuzzFeed News Any reimbursement from the insurance company (if any) would be paid directly to the patient. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 8. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 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. Post Surgery Recovery. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net 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. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. 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. Submission and review of physician-initiated appeal (1 month); 3. 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? 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. Surgery referral assessment requirements | Gender Affirming Health Program Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. 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. Denver Health to Offer Facial Feminization Gender Confirmation Surgery Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 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. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. 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. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. The work cannot be changed in any way or used commercially without permission from the journal. If performed all at once, FFS usually takes between 4- 8 hours. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. However, this has been a persuasive strategy in some cases. 3. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. The benefits of such coverage far exceed the insignificant costs. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. 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. 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. We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). We can't guarantee insurance coverage but we can guarantee to try our hardest! 1. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Patients were stratified into 3 groups by authorization process. The objective is to soften the facial . Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Canner JK, Harfouch O, Kodadek LM, et al. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 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. Transgender people report years of battles for health insurance coverage FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Facial Feminization Miami | The Maercks Institute 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. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. 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. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. KP FFS Surgeons. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 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. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. your express consent. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 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 . Average months spent from initial facial feminization consultation to final insurance authorization decision. 3). Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Out-of-pocket costs for FFS.