Plast Reconstr Surg. Read more. 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. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. We can't guarantee insurance coverage but we can guarantee to try our hardest! Additionally, planning and recovering from any trans surgery is hard! 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. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Braun TL, Braun JL, Hernandez C, et al. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). You will be asked to complete an intake questionnaire before your consultation. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . 2018; 153:609616. 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. Do you have out of network benefits, or are you limited to providers in the network? For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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. 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. 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. 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. This is their communication with the insurance company verifying that the procedure is covered. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. 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. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest. No. 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. 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. Temporal trends in gender-affirming surgery among transgender patients in the United States. The United States . Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Post Surgery Recovery. Prior to meeting with the social worker, patients should complete this assessment document. 2016. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. The benefits of such coverage far exceed the insignificant costs. 2003; 349:768775. Facial Feminisation Surgery | Nuffield Health Feminizing surgery - Mayo Clinic FFS: paying and picking a surgeon. Freaking out and need advice. She has the skill and artistry to help produce the aesthetic goals that transgender and non-binary patients seek with Top Surgery, Breast Augmentation and Facial Gender Confirmation Surgery. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 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. Both of these methods are. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Facial feminization surgery - Doctors & Departments - Mayo Clinic Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY Facial Feminization Surgery: What You Should Know - Healthline Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming 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. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? Dr. Facque joined the Gender Confirmation Centers team in September 2020 as a full-time Associate Surgeon specializing in Facial Gender Confirmation Surgery, Top Surgery and Body Contouring. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. Facial feminization surgery can be covered by health insurance in some instances. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Available at: 2. 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. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Private insurances included health maintenance organizations and preferred provider organization. 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. Facial Feminization Surgery Timeline - Gender Confirmation Facial Feminization Surgery: Everything You Need to Know - Verywell Health FFS is a cost-effective intervention that needs to be covered by insurance policies. Procedures requested for facial feminization insurance authorization are detailed in Table 2. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Gender Affirmation Atlanta GA | Facial Feminization Alpharetta He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 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. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Patients were stratified into 3 groups by authorization process. 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. The generalizability of the findings presented here is limited by state laws. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Please note that before you can schedule . 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.) Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. 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. 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. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 1. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 5. Facial Feminization Surgery Before & After Pictures - RealSelf 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. 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. 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. The blossoming of academic medical centers offering transgender surgical care also means that more well respected surgeons, with appropriate craniofacial and maxilliofacial reconstructive training, are able to do procedures through insurance. I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. 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. Two letters from mental health providers. 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. 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. may email you for journal alerts and information, but is committed Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization.
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