All patients with public insurance (Medi-Cal or Medicare) as well as a small subset of private insurance plans were approved after initial submission of authorization request or did not require approval before surgery (Medicare) (Fig. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. 2018; 153:609616. 1. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. 2). 2018; 80:198204. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). We have a dedicated Insurance Advocacy Team that handles the entire process of insurance approval for patients; we send all your documents to your insurance providers and work with them to try and secure coverage to the fullest extent. 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. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Days, whose birth name was Douglas, came out as transgender in January, 2015. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Facial Feminization Surgery (FFS) Preparation Guide. 2020; 8:e2618. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Ousterhout DK. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Braun TL, Braun JL, Hernandez C, et al. 2010; 19:10191024. What's your out of pocket max? Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Care Credit approval amounts can vary from person to person. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. There are a few limitations in this study that deserve mention. 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. 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. In fact, he is one of the most experienced gender surgeons in the world. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. 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. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Dr. Thomas Satterwhite Dr. Plastic and Cosmetic Surgery. Capitn L, Simon D, Kaye K, et al. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . 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. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . However, this has been a persuasive strategy in some cases. 14. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. 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). TransHealthCare.org uses cookies and other tracking technologies to improve your browsing experience on our website, to analyze our website traffic, and to understand where our visitors are coming from. Submission and review of second level, patient-initiated appeal (1 month); 4. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. This should be sent to you in written form, with the specific reason for the denial included. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 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. 2020 Deschamps-braly clinic. 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.) Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. 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. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 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. . It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. 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. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. 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. 3. For more information, please refer to our Privacy Policy. This process will be long and draining, but it is worth it. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. This is their communication with the insurance company verifying that the procedure is covered. 2016; 31:394401. JAMA Surg. 3). Read on to find out why you might pay more or less, and whether the cost is really worth it. Regardless, I recommend that you fight everything out in the preauthorization/pre service review process, and not after you have already paid and might be left holding the bill. Ask to speak to people's supervisors. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 8. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. I don't philosophically agree with this. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. The United States . Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. As an example, the typical timeline for our Group B and C patients is as follows: 1. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Support groups? You may be trying to access this site from a secured browser on the server. Do you have out of network benefits, or are you limited to providers in the network? Qual Life Res. Although your FFS may not be covered by your insurance company its definitely worth doing the research. Patients seeking services from our practice are personally and fully responsible for payment of all fees and costs related to your FFS surgery and medical care. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 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. Historically, FFS hasn't been covered by health insurance or government healthcare. Error bars denote standard error. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. During Your FFS Procedure How long it takes: This depends on what you are having done. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Choose from multiple implant types and sizes. This is the point at which you will likely need legal support. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Thus, coverage significantly increases accessibility. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 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. 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. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. 2). This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. 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). 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. Requires supporting documentation that indicates specific type of FFS procedures requested. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Costs of health care administration in the United States and Canada. Average months spent from initial facial feminization consultation to final insurance authorization decision. Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. 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. They submit their own information, information about the procedure being performed, and information about you. A letter from your primary care provider or whoever prescribes your hormones. 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. 1. 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. 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. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Everyone who is able to fight through it cracks the door open a little wider for the next person. 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. Facial feminization surgery can be covered by health insurance in some instances. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Plast Reconstr Surg. All rights reserved. *, Time and cost of the insurance approval process for FFS. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Until then, CCTS will continue to require all patients using insurance for . In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Arch Intern Med. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. 2018. Tseng P, Kaplan RS, Richman BD, et al. See all insurance information. (link is external) for CGSP. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient.