15. Dr. Charles Shih. 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). The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. Please try again soon. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. 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. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. 3). 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. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. I don't philosophically agree with this. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. No. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Capitn L, Simon D, Kaye K, et al. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. N Engl J Med. Error bars denote standard error. 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. James S, Herman J, Rankin S, et al. 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.) Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). J Gen Intern Med. This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Research that Matters. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. 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. Though WPATH has released the new SOC, it will take insurance companies time to evolve. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. 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 Qual Life Res. 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. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 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. Thus, coverage significantly increases accessibility. 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. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. 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. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Try your local trans advocacy groups, LGBTI legal services, support group, etc. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. 3. 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. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. However, some insurers are beginning to cover FFS from select surgeons. 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. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 6. 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. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. They submit their own information, information about the procedure being performed, and information about you. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. According to the Philadelphia Center for Transgender Surgery,. 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. In addition, many of them don't take insurance. Integral to this whole process is the FGCS surgeon. Tseng P, Kaplan RS, Richman BD, et al. Arch Intern Med. 2016. 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. Private insurances included health maintenance organizations and preferred provider organization. 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. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. https://links.lww.com/PRSGO/B648.). If it is substantial, they should name their years of experience working with transgender patients. 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. However, this is starting to change. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. An estimated 90% of all patient consults were approved for FFS under insurance. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 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. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. You may be trying to access this site from a secured browser on the server. You should be able to have easy access to this document through your insurance provider. 2016; 31:394401. The work cannot be changed in any way or used commercially without permission from the journal. Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. https://links.lww.com/PRSGO/B647.). The report of the 2015 U.S. transgender survey. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Plastic and Cosmetic Surgery. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? Dr. Andrew Kleinberger. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. How soon can I book a surgery date? Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. 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. 5. Descriptive statistics were performed for demographic variables. 2015; 136:560e561e. 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. Wolters Kluwer Health, Inc. All rights reserved. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Care Credit approval amounts can vary from person to person. Woolhandler S, Campbell T, Himmelstein DU. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. FFS is a cost-effective intervention that needs to be covered by insurance policies. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . 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. Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Please read a few important elements consider when booking. Furthermore, revisions may be indicated in some patients over time. Your message has been successfully sent to your colleague. 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. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Health insurance is unnecessarily difficult when it comes to gender affirming surgery.