Everyone who is able to fight through it cracks the door open a little wider for the next person. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Available at: 9. Facial feminization surgery (FFS): The permanent . Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. 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. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Ainsworth TA, Spiegel JH. A total of 36 patients (90.0%) have been approved by insurance. 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. 4. After a person pays the deductible, Medicare pays 80% of the allowable costs . 2. Plast Reconstr Surg. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. 13. San Francisco, CA 94108. 2015; 136:560e561e. 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). 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. 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. Rhinoplasty. Estimated costs of obtaining insurance approval for FFS (B). No. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. https://links.lww.com/PRSGO/B648.). Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. 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. 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. Your message has been successfully sent to your colleague. Braun TL, Braun JL, Hernandez C, et al. There are a few limitations in this study that deserve mention. 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. They submit their own information, information about the procedure being performed, and information about you. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. The benefits of such coverage far exceed the insignificant costs. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 1). Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Available at: 2. Plast Reconstr Surg. Your insurance might have a requirement about length of time in care with them, or degree level. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. 1. A prior authorization is not a guarantee of payment, therefore, you should have funds available to cover all fees and costs related to your surgery should your request be denied. J Gen Intern Med. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Furthermore, revisions may be indicated in some patients over time. 7. Second, while complications are not high in FFS, they may occur. 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. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. For more information, please refer to our Privacy Policy. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 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. 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? As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Have your facial features compromised your safety, making you a target for harassment and violence? A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. 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. Facial Feminization Surgery (FFS) Preparation Guide. 2019; 144:11591168. KP FFS Surgeons. Surgical techniques and analysis of results. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Requires supporting documentation that indicates specific type of FFS procedures requested. Data is temporarily unavailable. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. In fact, he is one of the most experienced gender surgeons in the world. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 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. Additionally, the patients who exited their employer-based plans to buy health insurance on the exchange paid more for health insurance by foregoing employer contributions. Capitn L, Simon D, Kaye K, et al. 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. Among the total cohort, most patients had private insurance (n = 23, 57.5%), followed by Medi-Cal (n = 13, 32.5%), and Medicare (n = 4, 10.0%). If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 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. 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. Ask to speak to people's supervisors. 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. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 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. 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. your express consent. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. 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. Post Surgery Recovery. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). If they are a member of WPATH or other applicable professional associations, they should name that. You will be asked to complete an intake questionnaire before your consultation. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Facial Feminization Surgery: A Guide for the Transgendered Woman. Patients were stratified into 3 groups by authorization process. While facial feminization surgery has many potential benefits, the decision to proceed . Choose from multiple implant types and sizes. 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. 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. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved.
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