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.). The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. 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. 2018; 319:691697. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Facial Feminization Surgery - Costs - What does FFS cost? - 2pass Clinic 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Facial Feminization Surgery (FFS) | Gender Affirming Health Program 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. Male-to-female (MTF) facial feminization. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. However, the cost can range from $1,847 to $62,000, depending on a few key factors. https://links.lww.com/PRSGO/B647.). 2014; 134:609619. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Braun TL, Braun JL, Hernandez C, et al. You will be asked to complete an intake questionnaire before your consultation. San Francisco, CA 94108. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Facial Feminisation Surgery | Nuffield Health To access this service, refer to the process below: Fill out and return the Service Inquiry Form. The administrator hourly compensation set at our institution was used for the cost analysis. The generalizability of the findings presented here is limited by state laws. The Case For Facial Feminization Surgery - BuzzFeed News Facial Feminization Surgery Cost - American Society of Plastic Surgeons Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Every state is different so start with Google and reach out to these services in your state, theyre here for you! How NOT To Choose Your Facial Feminization Surgeon As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Bariatric Surgery. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Facial Feminization Surgery: What Is FFS, Hairline - Cleveland Clinic 2018 Physician Compensation Report. 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. KP FFS Surgeons. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. See all insurance information. 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. Facial Feminization Surgery (FFS) in Mexico - MyMediTravel Thus, coverage significantly increases accessibility. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Please read a few important elements consider when booking. 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. information about insurance coverage: video.transcendlegal.org 2. 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. 15. 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. Paying for Transgender Surgeries - Investopedia surgical techniques and analysis of results. The Ins & Outs of Traveling Abroad for FFS Surgery Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. 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. Procedure. to maintaining your privacy and will not share your personal information without Dr. Thomas Satterwhite 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. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Please enable scripts and reload this page. 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. PDF Healthcare Laws and Policies: Medicaid Coverage for Transgender-Related Qual Life Res. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 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. 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. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Group A (standard approval) included patients who were approved after undergoing a standard authorization process, such as those with Medi-Cal, Medicare, and private insurance. Only if your insurance provider authorizes a Letter of Agreement. A total of 36 patients (90.0%) have been approved by insurance. Wolters Kluwer Health NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Now you will be denied! Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Until then, CCTS will continue to require all patients using insurance for . Try your local trans advocacy groups, LGBTI legal services, support group, etc. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado 3. Feminizing surgery - Mayo Clinic document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. Do you have access to out-of-network providers or in-network only. 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. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. Read on to find out why you might pay more or less, and whether the cost is really worth it. 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. 2016. The work cannot be changed in any way or used commercially without permission from the journal. 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. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. 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. 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. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). https://links.lww.com/PRSGO/B648.). The report of the 2015 U.S. transgender survey. $8995. 13. (link is external) for CGSP. 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. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. 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. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Facial Feminization in Korea - Everything You Need to Know! Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. They submit their own information, information about the procedure being performed, and information about you. Get a bossy friend to make phone calls with you while you are dealing with the process. 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. 3). Care Credit approval amounts can vary from person to person. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. 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. 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. ENQUIRE NOW. https://links.lww.com/PRSGO/B648.) . Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Health insurance Medical Policies - Trans Health Project 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). LGBT legal service projects? I am working from the perspective that you are unable to pay in full and be reimbursed. Available at: 9. You should be able to have easy access to this document through your insurance provider. Capitn L, Simon D, Kaye K, et al. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 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. Support groups? Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Does Medicare Cover Facial Feminization Surgery? FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. Dr. Charles Shih. Facial Feminization Surgery | Michigan Medicine - U of M Health Dr. Javad Sajan, MD is a Cosmetic, Plastic and Reconstructive Surgeon in Seattle who specializes in Gender-Affirming Surgery including Top Surgery, Breast Augmentation, Body Sculpting and Facial Feminization. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 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. 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 is more often referred to as "gender reaffirmation surgery", and is performed on . Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. 2). This is their communication with the insurance company verifying that the procedure is covered. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Do you have out of network benefits, or are you limited to providers in the network? 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Dr. Javad Sajan - Facial Feminization Surgery (FFS) in Seattle 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 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. The United States . 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. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. 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. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. 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. Transgender people report years of battles for health insurance coverage Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. 2. The doctor said very encouraging. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 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. Co-insurance past that? Submission and review of initial authorization request (1 month); 2. 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. The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction.
ffs surgeons who take insurance