Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Submission and review of IMR (1 month). There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. The structure of this system sucks, but it's the one in which you find yourself and it is your responsibility to make it work for you. They submit their own information, information about the procedure being performed, and information about you. 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. This is their communication with the insurance company verifying that the procedure is covered. Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Doctors and nurses take good care. 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. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. For patients anticipating insurance coverage for your surgery, we appreciate that you may wish to seek insurance reimbursement for the cost of some or all of your feminization procedures and have outlined some general guidelines below. Facial feminization surgery: the forehead. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. 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. 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. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 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. Plast Reconstr Surg. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). However, this has been a persuasive strategy in some cases. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. Dr. Otherwise, your deposit will be applied towards your surgical balance. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. Furthermore, revisions may be indicated in some patients over time. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 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. 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 . Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. What's your out of pocket max? Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. The doctor said very encouraging. All rights reserved. Please refer to theCare Credit websitefor further details. This process will be long and draining, but it is worth it. Facial Feminization Surgery (FFS) Preparation Guide. Estimated costs of obtaining insurance approval for FFS (B). *, Time and cost of the insurance approval process for FFS. 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. 2018; 153:609616. These procedures may include: Tummy tuck, called abdominoplasty. 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. Policy Title: Gender Affirming Surgery. The administrator hourly compensation set at our institution was used for the cost analysis. Are there transgender advocacy groups? 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. Wolters Kluwer Health, Inc. All rights reserved. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Facial Feminization Surgery: A Guide for the Transgendered Woman. 6. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. No. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Days, whose birth name was Douglas, came out as transgender in January, 2015. J Gen Intern Med. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Leigh JP, Tancredi D, Jerant A, et al. Read on to find out why you might pay more or less, and whether the cost is really worth it. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. 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. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. 2020; 8:e2618. Do you have a deductible to meet? 3). Dr. KathleynBrandstetter. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. 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. 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. 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. 2019; 144:11591168. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. https://links.lww.com/PRSGO/B647.). Everyone who is able to fight through it cracks the door open a little wider for the next person. It's hard for any person to find their voice to self-advocate when such deeply personal needs are up for debate and judgement as "cosmetic" among random insurance company reviewers. 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. 1. Procedures requested for facial feminization insurance authorization are detailed in Table 2. A letter from your primary care provider or whoever prescribes your hormones. 2018; 80:198204. https://links.lww.com/PRSGO/B648.). Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Please try again soon. While facial feminization surgery has many potential benefits, the decision to proceed . Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. In contrast, FFS under insurance coverage allows for inpatient care, which may be important, particularly to surgeon decision-making as well as patients who may have other medical conditions, pain control issues, or those who travel from long distances. 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. 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. Until then, CCTS will continue to require all patients using insurance for . Some error has occurred while processing your request. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 15. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. This is called facial feminization surgery. Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. Dr. Charles Shih. 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. 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. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Plastic surgery on the face. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. 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). 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. your express consent. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Surgical techniques and analysis of results. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. The United States . Thus, coverage significantly increases accessibility. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. 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. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. 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. This is also the point at which general 201 level guidance ceases to be useful. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. It's an attempt to make the face as attractive as possible for as long as it lasts. The work cannot be changed in any way or used commercially without permission from the journal. Two letters from mental health providers. Submission and review of second level, patient-initiated appeal (1 month); 4. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. 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. From the cohort, 3 subgroups were delineated. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Any reimbursement from the insurance company (if any) would be paid directly to the patient. Please read a few important elements consider when booking. Facial Feminization Surgery (FFS) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. 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. Plast Reconstr Surg Glob Open. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. I am working from the perspective that you are unable to pay in full and be reimbursed. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. James S, Herman J, Rankin S, et al. 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.) 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. Ainsworth TA, Spiegel JH. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 2. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 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. School-Based Dental Sealants; Licensed Rhode Island Dentists. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. . Tseng P, Kaplan RS, Richman BD, et al. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing.

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