Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. 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. 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. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 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. 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. He joined the Austin branch of the Crane Center for Transgender Surgery in 2021, where he offers Top Surgery and Breast Augmentation, Facial Feminization and Vaginoplasty. These delicate procedures change the male facial patterns to a softer, feminine appearance. The generalizability of the findings presented here is limited by state laws. The objective is to soften the facial . Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Doximity. The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. 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. Dr. Andrew Kleinberger. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Read on to find out why you might pay more or less, and whether the cost is really worth it. Conveniently Located to Serve Chicago and Illinois. Second, while complications are not high in FFS, they may occur. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Gray R, Nguyen K, Lee JC, et al. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 1. 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. Finding a Surgeon Integral to this whole process is the FGCS surgeon. The doctor said very encouraging. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. There are a few limitations in this study that deserve mention. Price (USD) Forehead Recontouring. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. In fact, he is one of the most experienced gender surgeons in the world. 2. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. Private insurances included health maintenance organizations and preferred provider organization. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. 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. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 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. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. The pre-surgical authorization process for patients in Groups B and C, constituting 60.8% of all private insurance patients in our cohort, is highly time-consuming due to the individual review periods required for each level. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Ousterhout DK. 10. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Days, a 50-year-old Berkeley resident, had just returned from a month-long trip to Spain in February, where she underwent a procedure known as facial feminization surgery, or FFS. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. FFS is a cost-effective intervention that needs to be covered by insurance policies. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. 2010; 170:17281734. 2016; 137:438448. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. 2010; 19:10191024. 1. A total of 36 patients (90.0%) have been approved by insurance. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Generally, one provider should have a doctoral level degree (PhD, DSW, Psychiatrist MD) and the other can have a masters level degree (MSW, MHC, etc.) See all insurance information. Ask to speak to people's supervisors. Requested CPT codes are detailed in Supplemental Digital Content 1. This is called facial feminization surgery. LGBT legal service projects? For example, some may be reluctant to perform an osteotomy of the anterior table of the frontal bone for setback in an outpatient surgery center and, thus, default to a less aggressive method of frontal bone recontouring, which may be an undercorrection for certain patients. Transgender women may choose FFS as part of their male-to-female transition process. Ultimately this letter is between you and your provider, but here is some sample language that has been helpful to patients I've worked with: "Patient X has been adherent to two years of hormone replacement therapy including (specific estrogen regimen.) 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. 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. We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. Schedule surgery The report of the 2015 U.S. transgender survey. KP FFS Surgeons. You should be able to have easy access to this document through your insurance provider. Co-insurance past that? 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. 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. 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. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Brow Lift. Some error has occurred while processing your request. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Every state is different so start with Google and reach out to these services in your state, theyre here for you! Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Though WPATH has released the new SOC, it will take insurance companies time to evolve. surgical techniques and analysis of results. Submission and review of IMR (1 month). Procedure. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Your scars may take up to a year to heal. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. $4985. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Dr. Thomas Satterwhite Doctors and nurses take good care. 4. 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. 8. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. 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. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Additionally, planning and recovering from any trans surgery is hard! 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. Error bars denote standard error. Dr. Freet accepts both insurance and Medicare. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. She has the skill and artistry to help produce the aesthetic goals that transgender and non-binary patients seek with Top Surgery, Breast Augmentation and Facial Gender Confirmation Surgery. I always advise people to try with the insurance they have before they switch to another plan. 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). 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. While facial feminization surgery has many potential benefits, the decision to proceed . information about insurance coverage: video.transcendlegal.org 2. Months required for definitive insurance authorization decisions for FFS. 2). This is the point at which you will likely need legal support. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. your express consent. 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. Facial feminization surgery: the forehead. The benefits of such coverage far exceed the insignificant costs. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. 3). 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.
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