The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization 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. Estimated costs of obtaining insurance approval for FFS (B). These procedures may include: Tummy tuck, called abdominoplasty. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. 2015; 136:560e561e. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Days, whose birth name was Douglas, came out as transgender in January, 2015. 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. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. If it is substantial, they should name their years of experience working with transgender patients. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 3. The generalizability of the findings presented here is limited by state laws. https://links.lww.com/PRSGO/B648.). Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 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. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. 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. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. The United States . Please refer to theCare Credit websitefor further details. 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). Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 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. 1). This process will be long and draining, but it is worth it. The Group C authorization process, which resulted in denial of services, consumed a 9-fold higher amount of time (P < 0.001) and 26-fold higher cost (P < 0.001) when compared with Group A (Fig. Facial feminization surgery (FFS): The permanent . Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Prior to meeting with the social worker, patients should complete this assessment document. However, this has been a persuasive strategy in some cases. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Finally, you should have an idea of your local resources. 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. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Two letters from mental health providers. 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 . Have your facial features compromised your safety, making you a target for harassment and violence? Most other insurance plans do not cover FFS and consider it as cosmetic surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Read more about our Clinics Finance and Insurance Policy here. During Your FFS Procedure How long it takes: This depends on what you are having done. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. 2018 Physician Compensation Report. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Ainsworth TA, Spiegel JH. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. 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.) Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Only if your insurance provider authorizes a Letter of Agreement. 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. Body-contouring. 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. Your scars may take up to a year to heal. According to the Philadelphia Center for Transgender Surgery,. Want to use our data? Thus, coverage significantly increases accessibility. JAMA Surg. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 2016; 31:394401. These delicate procedures change the male facial patterns to a softer, feminine appearance. Otherwise, your deposit will be applied towards your surgical balance. 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. Doximity. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Every state is different so start with Google and reach out to these services in your state, theyre here for you! The benefits of such coverage far exceed the insignificant costs. 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. Ann Plast Surg. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. A total of 36 patients (90.0%) have been approved by insurance. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Every insurance company is "difficult" to work with. 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. 1. If performed all at once, FFS usually takes between 4- 8 hours. 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. 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. FFS is a cost-effective intervention that needs to be covered by insurance policies. 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]. Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Please try after some time. Compared with the published literature, patients within Groups B and C are multi-fold greater than the reported standard estimates in the former study without even taking into account time and costs of post-surgical billing activities. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Finding a Surgeon Integral to this whole process is the FGCS surgeon. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . You will be asked to complete an intake questionnaire before your consultation. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. However, some insurers are beginning to cover FFS from select surgeons. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Gray R, Nguyen K, Lee JC, et al. Dr. While facial feminization surgery has many potential benefits, the decision to proceed . N Engl J Med. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. 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. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." 2018; 80:198204. 6. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. Out-of-pocket costs for FFS. Location: Bangkok, Thailand. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. This is also the point at which general 201 level guidance ceases to be useful. 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. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Plast Reconstr Surg Glob Open. Physician wages across specialties: informing the physician reimbursement debate. $8995. Requires supporting documentation that indicates specific type of FFS procedures requested. Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. James S, Herman J, Rankin S, et al. 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. Please enable scripts and reload this page. 2020 Deschamps-braly clinic. Additionally, the patients who exited their employer-based plans to buy health insurance on the exchange paid more for health insurance by foregoing employer contributions. 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. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Submission and review of IMR (1 month). 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? Furthermore, revisions may be indicated in some patients over time. 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 (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. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. 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. Read on to find out why you might pay more or less, and whether the cost is really worth it. 1. For example, there are now many hospitals across the . Costs of health care administration in the United States and Canada. Ousterhout DK. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Do you have a deductible to meet? No. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. 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). 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. P < 0.05 was considered significant. 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. She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. 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. The analysis was done by identifying individual steps involved in the insurance process (Fig. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Available at: 9. 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. Price (USD) Forehead Recontouring. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Though WPATH has released the new SOC, it will take insurance companies time to evolve. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 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. However, this is starting to change. The doctor said very encouraging. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 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. 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. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group.