To access this service, refer to the process below: Fill out and return the Service Inquiry Form. *, Time and cost of the insurance approval process for FFS. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Dr. Charles Shih. Choose from multiple implant types and sizes. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Ainsworth TA, Spiegel JH. 3). Notes. They accept most major insurances and work to help you get your surgery fully covered whenever possible. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. When it comes to facial feminization there is no substitute for experience. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. 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. 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. 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. Until then, CCTS will continue to require all patients using insurance for . 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. As an example, the typical timeline for our Group B and C patients is as follows: 1. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Historically, FFS hasn't been covered by health insurance or government healthcare. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Price (USD) Forehead Recontouring. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 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. 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 process will be long and draining, but it is worth it. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Male-to-female (MTF) facial feminization. Co-insurance past that? Read more. 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. As with any surgical procedure, there are risks associated with FFS. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Support groups? 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. 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. Start with ensuring that you have an in-depth understanding of your insurance benefits. 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. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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. 1. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. 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. Do you have out of network benefits, or are you limited to providers in the network? This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. In contrast to Group A, patients who required significant efforts in the form of multi-level appeals, peer-to-peer reviews, and IMRs were designated Groups B and C, depending on ultimate approval versus denial as the outcomes, respectively. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. 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 Now you will be denied! Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. You will be asked to complete an intake questionnaire before your consultation. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 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. Submission and review of initial authorization request (1 month); 2. 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). Both of these methods are. Woolhandler S, Campbell T, Himmelstein DU. may email you for journal alerts and information, but is committed Arch Intern Med. The addition of multi-level appeals in Groups B and C increased the total time for a definitive decision (7.0 and 5.1 months, respectively) and required both surgeon and administrative time to navigate the process (10.8 and 12.0 hours, respectively). Dr. Freet accepts both insurance and Medicare. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. 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. 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Your message has been successfully sent to your colleague. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. 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. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Read more about our Clinics Finance and Insurance Policy here. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. J Gen Intern Med. Physician wages across specialties: informing the physician reimbursement debate. Requested CPT codes are detailed in Supplemental Digital Content 1. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. A letter from your primary care provider or whoever prescribes your hormones. The report of the 2015 U.S. transgender survey. 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. 3. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. San Francisco, CA 94108. Look here for licensed dentists practicing in the state. Schedule 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. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 6. In the standard approval process (Group A), patients were under both public and certain private insurance plans (39% of all privately insured patients in the cohort). 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. Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. Days, whose birth name was Douglas, came out as transgender in January, 2015. Submission and review of IMR (1 month). We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. 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. Gray R, Nguyen K, Lee JC, et al. 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. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. 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. 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. The analysis was done by identifying individual steps involved in the insurance process (Fig. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. Simplifying facial feminization surgery using virtual modeling on the female skull. The benefits of such coverage far exceed the insignificant costs. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. For example, there are now many hospitals across the . Second, while complications are not high in FFS, they may occur. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Do you have access to out-of-network providers or in-network only. Plastic and Cosmetic Surgery. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery.