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Get a bossy friend to make phone calls with you while you are dealing with the process. 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. 7. Ask to speak to people's supervisors. Male-to-female (MTF) facial feminization. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. The time spent on the presurgical authorization process for Groups B and C translated to an over 20-fold increase in cost ($855.00 and $988.38, respectively) compared with Group A. Navigation of the insurance process for FFS is challenging and time-consuming; however, coverage is a reality in California provided that multi-level appeals are exhausted. Estimated costs of obtaining insurance approval for FFS (B). Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Read more. https://links.lww.com/PRSGO/B648.). Dr. Gurjala joined Align Surgical Associates in 2019, after five years of performing gender surgery, microsurgery, and general reconstructive and aesthetic surgery in the Kaiser Permanente healthcare network. If it is substantial, they should name their years of experience working with transgender patients. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? Thus, coverage significantly increases accessibility. 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. 2018. 2. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. The analysis was done by identifying individual steps involved in the insurance process (Fig. Ask them how many FFS surgeries they perform within a year. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. However, some insurers are beginning to cover FFS from select surgeons. Post Surgery Recovery. James S, Herman J, Rankin S, et al. Available at: 2. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Denial overturn was either mandated by the California Department of Managed Healthcare for California-insured plans or by the respective insurance companies for self-insured, employer-based plans under the Employee Retirement Income Security Act of 1974 (ERISA). This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. School-Based Dental Sealants; Licensed Rhode Island Dentists. 1. In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. Dr. Error bars denote standard error. Ann Plast Surg. How soon can I book a surgery date? 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. Average months spent from initial facial feminization consultation to final insurance authorization decision. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Support groups? Procedures requested for facial feminization insurance authorization are detailed in Table 2. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Dr. Thomas Satterwhite Beginning in June 2021, Dr. Esmonde will serve as a full-time Associate Surgeon with The Meltzer Clinic offering the full spectrum of gender-affirming procedures. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. I tell everyone to plan for an initial denial- even if FGCS is covered in your plan clearly, its likely that portions of the procedure will be denied as cosmetic. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 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. He has been performing gender surgery since 2005. Facial feminization surgery can be covered by health insurance in some instances. 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. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. All rights reserved. Read more about our Clinics Finance and Insurance Policy here. 14. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. 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. In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. JAMA. One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. 8. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 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 . Read more on our Insurance and Finance page. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Privacy Policy (Updated December 15, 2022). The United States . Care Credit approval amounts can vary from person to person. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. 2). Otherwise, your deposit will be applied towards your surgical balance. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization 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. This is also the point at which general 201 level guidance ceases to be useful. Finding a Surgeon Integral to this whole process is the FGCS surgeon. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 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. 2003; 349:768775. As with any surgical procedure, there are risks associated with FFS. You may be trying to access this site from a secured browser on the server. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. The benefits of such coverage far exceed the insignificant costs. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Integral to this whole process is the FGCS surgeon. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Please note that before you can schedule . 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. Plast Reconstr Surg. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. 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. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. This process will be long and draining, but it is worth it. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. This should be sent to you in written form, with the specific reason for the denial included. 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. 2). Qual Life Res. Additionally, planning and recovering from any trans surgery is hard! The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Canner JK, Harfouch O, Kodadek LM, et al. 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. Submission and review of initial authorization request (1 month); 2. 3). In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Requires supporting documentation that indicates specific type of FFS procedures requested. Procedure. After a person pays the deductible, Medicare pays 80% of the allowable costs . This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Finally, you should have an idea of your local resources. For more information, please refer to our Privacy Policy. 1. Facial feminization surgery (FFS): The permanent . Among the total cohort, most patients had private insurance (n = 23, 57.5%), followed by Medi-Cal (n = 13, 32.5%), and Medicare (n = 4, 10.0%). 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.