Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. Facial Feminization Surgery Before & After Pictures - RealSelf I am working from the perspective that you are unable to pay in full and be reimbursed. Every insurance company is "difficult" to work with. 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. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. Simplifying facial feminization surgery using virtual modeling on the female skull. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Facial Feminization Surgery (FFS) | University of Miami Health System You may be trying to access this site from a secured browser on the server. You will be asked to complete an intake questionnaire before your consultation. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Upon denial, an IMR is requested directly from the insurance plan. Facial Feminization Surgery NYC | Board Certified Plastic Surgeon In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Out-of-pocket costs for FFS. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. 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. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Gender Affirmation Surgery - University of Utah 12. 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. Read this first. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. This is also the point at which general 201 level guidance ceases to be useful. 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). We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. In total, the time and cost estimate of the insurance appeal process was 10.8 1.0 hours and $855.00 91.53 per patient, respectively. We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). However, this has been a persuasive strategy in some cases. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 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). 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. Get a bossy friend to make phone calls with you while you are dealing with the process. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. Post-surgery garments; Medical tests and x-rays; When choosing a board-certified plastic surgeon for facial feminization surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Care Credit approval amounts can vary from person to person. Gender-Affirmation Surgery | Transgender Surgery | The University of . Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist). The work cannot be changed in any way or used commercially without permission from the journal. 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. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. 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 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. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. 2010; 170:17281734. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 6. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 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. Arch Intern Med. We can't guarantee insurance coverage but we can guarantee to try our hardest! Days, whose birth name was Douglas, came out as transgender in January, 2015. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Temporal trends in gender-affirming surgery among transgender patients in the United States. Error bars denote standard error. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. If performed all at once, FFS usually takes between 4- 8 hours. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Tseng P, Kaplan RS, Richman BD, et al. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. 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. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Please first read this resource for a general overview of insurance utilization for trans surgery. How Do I Pay For Facial Feminization Surgery? - drbastidas.com Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. How soon can I book a surgery date? Facial Feminization Surgery (FFS) in Mexico - MyMediTravel The pre-surgical authorization process for patients in Groups B and C, constituting 60.8% of all private insurance patients in our cohort, is highly time-consuming due to the individual review periods required for each level. 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. 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. 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. How to Pay for Gender-Affirming Surgery - NerdWallet Padula WV, Heru S, Campbell JD. The doctor said very encouraging. 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. Policy Issued By: Anthem. 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. Two letters from mental health providers. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Facial Feminization Surgery (FFS) in Thailand - MyMediTravel Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. How Much Does Facial Feminization Surgery Cost? | RealSelf Denver Health to Offer Facial Feminization Gender Confirmation Surgery Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Facial Feminization Surgery (FFS) Preparation Guide. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. 3). Conveniently Located to Serve Chicago and Illinois. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. For more information, please refer to our Privacy Policy. Available at: 9. Yet, a number of studies have demonstrated that FFS is not only associated with improvement in quality of life for transfeminine patients, but also, for some patients, the most important aspect of transition.47 Although significant barriers exist, an improvement in insurance coverage for FFS has occurred over time, albeit navigation of the process is both laborious and confusing. Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. 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. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Location: Bangkok, Thailand. Best FFS Surgeons: What to Know and Where to Go Facialteam The administrator hourly compensation set at our institution was used for the cost analysis. Plast Reconstr Surg. 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. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 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. 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. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. . Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. I always advise people to try with the insurance they have before they switch to another plan. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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. 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. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Transgender women may choose FFS as part of their male-to-female transition process. Facial feminization surgery: the forehead. 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. FFS: money and choosing a surgeon : r/Transgender_Surgeries 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. 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. After a person pays the deductible, Medicare pays 80% of the allowable costs . Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Facial Feminization Surgery: A Guide for the Transgendered Woman. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Find a Surgeon for Gender Affirming Surgery - TransHealthCare 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. FHS/FFS (Facial Harmonization Surgery / Facial Feminization Surgery) Metoidioplasty/Phalloplasty Vaginoplasty/Vulvoplasty Classes cover the following material: Surgical options and techniques Surgery planning and pathway at Kaiser Post-operative care and recovery Most sessions also include a patient panel Plast Reconstr Surg. Research that Matters. 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. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . 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. 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. Facial feminization surgery: the forehead. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic 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. 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. Your scars may take up to a year to heal. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. 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.). 1. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries.