Location: Bangkok, Thailand. KP FFS Surgeons. Read more. Dr. Months required for definitive insurance authorization decisions for FFS. 1. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Integral to this whole process is the FGCS surgeon. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Descriptive statistics were performed for demographic variables. Plastic and Cosmetic Surgery. 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. 14. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. 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. Please note that before you can schedule . Received for publication February 2, 2021; accepted February 27, 2021. In addition, many of them don't take insurance. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Woolhandler S, Campbell T, Himmelstein DU. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Qual Life Res. 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. It's an attempt to make the face as attractive as possible for as long as it lasts. I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. 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. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. 2018 Physician Compensation Report. 13. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Submission and review of IMR (1 month). Facial feminization surgery can be covered by health insurance in some instances. 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). Furthermore, revisions may be indicated in some patients over time. The United States . FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 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. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Surgical techniques and analysis of results. Do you have access to out-of-network providers or in-network only. Facial Reconstruction: Gender affirming facial surgery is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age; and Plast Reconstr Surg. 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. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). Submission and review of physician-initiated appeal (1 month); 3. 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? In addition to administrative time, multi-level appeals required time from the attending craniofacial surgeon for peer-to-peer reviews, writing appeal letters, and patient counseling over the 6-month period, in total averaging 3.6 0.5 hours per patient. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. They submit their own information, information about the procedure being performed, and information about you. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. Some of the procedures included in facial feminization surgery are: In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. Please read a few important elements consider when booking. 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. 2). Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 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. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Look here for licensed dentists practicing in the state. 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. 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 rare instance that FFS Surgery is included in your health insurance policy, services may be incomplete or function only on a reimbursement basis. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Submission and review of initial authorization request (1 month); 2. Only patients with insurance authorization decisions were included in this study (n = 40). From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 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. Finally, you should have an idea of your local resources. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. 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. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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). Ask to speak to people's supervisors. Have your facial features compromised your safety, making you a target for harassment and violence? The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Physician wages across specialties: informing the physician reimbursement debate. Start with ensuring that you have an in-depth understanding of your insurance benefits. 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. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. https://links.lww.com/PRSGO/B648.). 2019; 144:11591168. 1). 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. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. This is the point at which you will likely need legal support. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. In total, the time and cost estimate of the insurance appeal process was 10.8 1.0 hours and $855.00 91.53 per patient, respectively. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. In fact, he is one of the most experienced gender surgeons in the world. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Plast Reconstr Surg Glob Open. Ann Plast Surg. 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. Upon denial, an IMR is requested directly from the insurance plan. 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. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. Procedures requested for facial feminization insurance authorization are detailed in Table 2. A total of 36 patients (90.0%) have been approved by insurance. When it comes to facial feminization there is no substitute for experience. Your message has been successfully sent to your colleague. Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Gray R, Nguyen K, Lee JC, et al. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Plastic surgery on the face. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Post Surgery Recovery. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. 4. 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 other insurance plans do not cover FFS and consider it as cosmetic surgery. This is also the point at which general 201 level guidance ceases to be useful. Research that Matters. 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. Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. *, Time and cost of the insurance approval process for FFS. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Care Credit approval amounts can vary from person to person. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Complete New Patient Questionnaire. Dr. Freet accepts both insurance and Medicare. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Policy Title: Gender Affirming Surgery. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. 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). Leigh JP, Tancredi D, Jerant A, et al. Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. If it is substantial, they should name their years of experience working with transgender patients. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. You may be trying to access this site from a secured browser on the server. 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. Data is temporarily unavailable. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 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. No. This should be sent to you in written form, with the specific reason for the denial included. 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. Historically, FFS hasn't been covered by health insurance or government healthcare. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Ainsworth TA, Spiegel JH. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators.
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