2020 Deschamps-braly clinic. The report of the 2015 U.S. transgender survey. 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. Post Surgery Recovery. Additionally, planning and recovering from any trans surgery is hard! Ask to speak to people's supervisors. Read more. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. information about insurance coverage: video.transcendlegal.org 2. Ousterhout DK. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. I could go on about this, but I hate to further the expectation that you must be very mentally ill in order for the "extreme" treatment of FGCS to be warranted. Your insurance might have a requirement about length of time in care with them, or degree level. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. to maintaining your privacy and will not share your personal information without This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 2020; 8:e2618. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. Do you have access to out-of-network providers or in-network only. Body-contouring. Ask them how many FFS surgeries they perform within a year. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Plast Reconstr Surg. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 1). Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. 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. An estimated 90% of all patient consults were approved for FFS under insurance. Please first read this resource for a general overview of insurance utilization for trans surgery. Facial feminization surgery (FFS): The permanent . Care Credit approval amounts can vary from person to person. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . $4985. 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). 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. Get a bossy friend to make phone calls with you while you are dealing with the process. P < 0.05 was considered significant. Total Staff: 34. Choose from multiple implant types and sizes. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. Integral to this whole process is the FGCS surgeon. Received for publication February 2, 2021; accepted February 27, 2021. Transgender women may choose FFS as part of their male-to-female transition process. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 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. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 2). For patients anticipating insurance coverage for your surgery, we appreciate that you may wish to seek insurance reimbursement for the cost of some or all of your feminization procedures and have outlined some general guidelines below. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. https://links.lww.com/PRSGO/B648.) 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. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Dr. 1. 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. 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. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. In fact, he is one of the most experienced gender surgeons in the world. 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). Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Complete New Patient Questionnaire. Average months spent from initial facial feminization consultation to final insurance authorization decision. . Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). You may be trying to access this site from a secured browser on the server. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Facial feminization surgery: the forehead. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. Available at: 2. Out-of-pocket costs for FFS. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 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. Read this first. 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. 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. Privacy Policy (Updated December 15, 2022). Finding a Surgeon Integral to this whole process is the FGCS surgeon. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. A total of 36 patients (90.0%) have been approved by insurance. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). 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. 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. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. As with any surgical procedure, there are risks associated with FFS. Prior to meeting with the social worker, patients should complete this assessment document. 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. As an example, the typical timeline for our Group B and C patients is as follows: 1. Tseng P, Kaplan RS, Richman BD, et al. I don't philosophically agree with this. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. For example, there are now many hospitals across the . However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 10. 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 From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. 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. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Patients were stratified into 3 groups by authorization process. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Our practice does NOT contract with any insurance providers to allay the cost of your 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. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. The administrator hourly compensation set at our institution was used for the cost analysis. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Second, while complications are not high in FFS, they may occur. 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 . According to the Philadelphia Center for Transgender Surgery,. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 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. Historically, FFS hasn't been covered by health insurance or government healthcare. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. 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. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Read on to find out why you might pay more or less, and whether the cost is really worth it. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery.

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