";s:4:"text";s:23407:" Simplifying facial feminization surgery using virtual modeling on the female skull. 11. One of the major issues among surgeons and patients with regard to insurance coverage for FFS is the lack of understanding of the process as coverage for gender healthcare is highly variable depending on state law and plan variabilities (Table 3). We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Physician wages across specialties: informing the physician reimbursement debate. 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.) Only patients with insurance authorization decisions were included in this study (n = 40). Some error has occurred while processing your request. 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. 4. As an example, the typical timeline for our Group B and C patients is as follows: 1. Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. 2010; 19:10191024. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 8. This is their communication with the insurance company verifying that the procedure is covered. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Capitn L, Simon D, Kaye K, et al. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Do you have access to out-of-network providers or in-network only. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Gray R, Nguyen K, Lee JC, et al. They accept most major insurances and work to help you get your surgery fully covered whenever possible. It's an attempt to make the face as attractive as possible for as long as it lasts. 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. Please refer to theCare Credit websitefor further details. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 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.). Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. Leigh JP, Tancredi D, Jerant A, et al. P < 0.05 was considered significant. Plast Reconstr Surg Glob Open. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. 2003; 349:768775. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 2019; 144:11591168. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Padula WV, Heru S, Campbell JD. Wolters Kluwer Health, Inc. All rights reserved. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. 2). Patients were stratified into 3 groups by authorization process. 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. 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? 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. 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Error bars denote standard error. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Both of these methods are. 5. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Compared with the published literature, patients within Groups B and C are multi-fold greater than the reported standard estimates in the former study without even taking into account time and costs of post-surgical billing activities. 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. 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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. 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. How soon can I book a surgery date? He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. FFS is a cost-effective intervention that needs to be covered by insurance policies. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. As with any surgical procedure, there are risks associated with FFS. This process will be long and draining, but it is worth it. Error bars denote standard error. 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. Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. $4985. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Dr. Andrew Kleinberger. 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. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Jess Ting - Plastic and Reconstructive Surgery | Mount Sinai - New York Home Profiles Mount Sinai Doctors Video Visit Available Accepting New Patients Jess Ting, MD Plastic and Reconstructive Surgery 4.6 Star s | 32 Responses CTMS 212-870-8270 View location details Book an Appointment About Me Clinical Focus Video Education & Certifications Awards On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Do you have out of network benefits, or are you limited to providers in the network? Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. 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. After a person pays the deductible, Medicare pays 80% of the allowable costs . 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. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Notes. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. JAMA. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. 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. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. 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. 2. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. 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. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Requires supporting documentation that indicates specific type of FFS procedures requested. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. During Your FFS Procedure How long it takes: This depends on what you are having done. However, some insurers are beginning to cover FFS from select surgeons. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. Doctors and nurses take good care. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Facial feminization surgery: the forehead. 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. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). An estimated 90% of all patient consults were approved for FFS under insurance. https://links.lww.com/PRSGO/B647.). Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. For example, there are now many hospitals across the . It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. Plastic and Cosmetic Surgery. Dr. Thomas Satterwhite Procedure. Read more on our Insurance and Finance page. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Your insurance might have a requirement about length of time in care with them, or degree level. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. 2016; 137:438448. surgical techniques and analysis of results. 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. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Hu, Allison C. BA*; Dang, Brian N. BS*; Bertrand, Anthony A. MD, MBA*; Jain, Nirbhay S. MD*; Chan, Candace H. BS*; Lee, Justine C. MD, PhD, FACS*,. Canner JK, Harfouch O, Kodadek LM, et al. Plast Reconstr Surg. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. 6. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted. In addition, many of them don't take insurance. This could be a good time to join (or form!) Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. For people without local connections, the facebook group, " FFS Facial Feminization Surgery / Transgender TG TS " and the FFS Forums on susans.org are good places to seek community support as well. 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. Male-to-female (MTF) facial feminization. 2014; 134:609619. Private insurances included health maintenance organizations and preferred provider organization. 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. Dr. KathleynBrandstetter. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . *, Time and cost of the insurance approval process for FFS. Total Staff: 34. Ainsworth TA, Spiegel JH. 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. The analysis was done by identifying individual steps involved in the insurance process (Fig. 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. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 This could include either shaving down or entirely re-contouring the forehead/eyesockets/sinus area using osteotomies (cutting and repositioning bones), shaving the jaw line or a sliding genioplasty (reduction and/or re-positioning of the jaw bone), lifting the upper lip, rhinoplasty (nose job), and bringing the hair line further forward, in addition to other various soft tissue facial adjustments and reduction of the adams apple. Surgeons who practice facial gender confirming surgery often have special training in reconstructing facial features using bone grafting beyond a traditional plastic surgery residency. Complete New Patient Questionnaire. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. There are a few limitations in this study that deserve mention. 3). The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. Available at: 9. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. 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. 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. ";s:7:"keyword";s:31:"ffs surgeons who take insurance";s:5:"links";s:851:"How Deep Is The Frost Line In Texas,
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