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. Only if your insurance provider authorizes a Letter of Agreement. 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). Integral to this whole process is the FGCS surgeon. For more information, please refer to our Privacy Policy. The benefits of such coverage far exceed the insignificant costs. Want to use our data? FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Please first read this resource for a general overview of insurance utilization for trans surgery. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Requested CPT codes are detailed in Supplemental Digital Content 1. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. The cost of the administrative and attending craniofacial surgeon effort for Groups B and C averaged approximately $900, over 20-fold more than Group A. Padula WV, Heru S, Campbell JD. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 12. Procedure. 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. With a view to clarifying this issue and answering frequently asked questions, we have compiled the following information in an effort to not only outline how Deschamps-Braly Clinic handles finance and insurance coverage but to also provide general information about how to approach your own health insurance company regarding the cost of your facial feminization. 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. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Requires supporting documentation that indicates specific type of FFS procedures requested. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 2020; 8:e2618. Plastic surgery on the face. 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. I am working from the perspective that you are unable to pay in full and be reimbursed. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. . He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 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. 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. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Bariatric Surgery. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. $8995. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. Get a bossy friend to make phone calls with you while you are dealing with the process. 6. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Facial feminization surgery: the forehead. Facial Feminization Surgery (FFS) Preparation Guide. Post Surgery Recovery. 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. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Otherwise, your deposit will be applied towards your surgical balance. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. 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). You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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. Justine C. Lee, MD, PhD, FACS, University of California, Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960, E-mail: [emailprotected]. https://links.lww.com/PRSGO/B648.). Plast Reconstr Surg. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. While facial feminization surgery has many potential benefits, the decision to proceed . In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. 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). Historically, FFS hasn't been covered by health insurance or government healthcare. 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. Capitn L, Simon D, Kaye K, et al. 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. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. 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. From the cohort, 3 subgroups were delineated. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 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. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Hoang H, Bertrand AA, Hu AC, et al. 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. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Read more on our Insurance and Finance page. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 3. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Read this first. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Some of the procedures included in facial feminization surgery are: 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). Our team will help you set up a MyChart account where you will have the ability to fill this out online. 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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. 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. 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. How soon can I book a surgery date? 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. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. This should be sent to you in written form, with the specific reason for the denial included. 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. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 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). 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. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Facial Feminization Surgery: A Guide for the Transgendered Woman. All rights reserved. Look here for licensed dentists practicing in the state. Do you have access to out-of-network providers or in-network only. 2018; 319:691697. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Please enable scripts and reload this page. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. If they are a member of WPATH or other applicable professional associations, they should name that. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. Surgical techniques and analysis of results. Support groups? In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Qual Life Res. Our current work highlights the high likelihood of success in FFS coverage under insurance in California, but also details the challenges that plastic surgeons and plastic surgery practices incur for coverage to occur.
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