No. 2020; 8:e2618. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Total Staff: 34. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Call 913-588-6200 to request a consultation. Male-to-Female Surgery in Texas - Dr. Dulin - MTFsurgery.net 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. Read more on our Insurance and Finance page. Body-contouring. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. An estimated 90% of all patient consults were approved for FFS under insurance. For Bay Area trans women, facial feminization surgery helps complete 3). The analysis was done by identifying individual steps involved in the insurance process (Fig. 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). Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 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 administrator hourly compensation set at our institution was used for the cost analysis. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Please refer to theCare Credit websitefor further details. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. 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. After a person pays the deductible, Medicare pays 80% of the allowable costs . Though WPATH has released the new SOC, it will take insurance companies time to evolve. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. 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. The format for an appeals process and regulations/law/policy to cite within it vary widely depending on the mix of state and local regulations that apply to your specific plan. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Wolters Kluwer Health 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. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 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. 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. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Support groups? Available at: 2. Only patients with insurance authorization decisions were included in this study (n = 40). You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. They submit their own information, information about the procedure being performed, and information about you. Using Insurance for Facial Gender Confirming Surgery or "FFS" Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. This is their communication with the insurance company verifying that the procedure is covered. 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. 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. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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. Doctors and nurses take good care. However, the cost can range from $1,847 to $62,000, depending on a few key factors. This could include either shaving down or entirely re-contouring the forehead/eyesockets/sinus area using osteotomies (cutting and repositioning bones), shaving the jaw line or a sliding genioplasty (reduction and/or re-positioning of the jaw bone), lifting the upper lip, rhinoplasty (nose job), and bringing the hair line further forward, in addition to other various soft tissue facial adjustments and reduction of the adams apple. Surgeons who practice facial gender confirming surgery often have special training in reconstructing facial features using bone grafting beyond a traditional plastic surgery residency. 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. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. In addition, many of them don't take insurance. Does Medicare cover gender reassignment surgery? - Medical News Today Plast Reconstr Surg. 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. 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. JAMA Surg. We hope our in-person consultation will answer all of your questions, provide your sense of confidence and also further your excitement of the path you are on. Submission and review of IMR (1 month). 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. 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. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Top facial feminization surgeons will typically undertake 2-3 facial full feminization procedures a week, this equates to at least 100 or more a year. Among the various gender-affirming procedures, facial feminization surgery (FFS) is arguably the most commonly denied surgery, as insurance companies often deem the involved procedures as cosmetic and not medically necessary. Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery 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. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. The Ins & Outs of Traveling Abroad for FFS Surgery During Your FFS Procedure How long it takes: This depends on what you are having done. 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. 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. Facial Feminization Surgery (FSS) Houston and The Woodlands On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. 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. 6. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Policy Title: Gender Affirming Surgery. 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 . This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). https://links.lww.com/PRSGO/B648.). Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Dr. Javad Sajan - Facial Feminization Surgery (FFS) in Seattle 1. 2018; 80:198204. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. This could be a good time to join (or form!) Transgender people report years of battles for health insurance coverage Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Ousterhout DK. 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. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. 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.) Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 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). Facial Feminization Surgery: FFS Surgery in Thailand 2). I could go on about this, but I hate to further the expectation that you must be very mentally ill in order for the "extreme" treatment of FGCS to be warranted. 2015; 136:560e561e. 8. 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. Please note that before you can schedule . His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. your express consent. 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. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 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. In fact, he is one of the most experienced gender surgeons in the world. 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. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. 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. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Your insurance might have a requirement about length of time in care with them, or degree level. Finally, you should have an idea of your local resources. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. This should be sent to you in written form, with the specific reason for the denial included. 2018; 153:609616. For example, there are now many hospitals across the . FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Facial Feminization Surgery (FFS) | Gender Affirming Health Program I always advise people to try with the insurance they have before they switch to another plan. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. It's an attempt to make the face as attractive as possible for as long as it lasts. 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. Ask them how many FFS surgeries they perform within a year. Facial Feminization Surgery: What You Should Know - Healthline Try your local trans advocacy groups, LGBTI legal services, support group, etc. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Facial Feminization Miami | The Maercks Institute The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. James S, Herman J, Rankin S, et al. Facial Feminization Surgery | Michigan Medicine - U of M Health We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form.