These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. However, some insurers are beginning to cover FFS from select surgeons. This should be sent to you in written form, with the specific reason for the denial included. 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. Braun TL, Braun JL, Hernandez C, et al. 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. LGBT legal service projects? The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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. For more information, please refer to our Privacy Policy. 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. Two letters from mental health providers. In addition to administrative time, multi-level appeals required time from the attending craniofacial surgeon for peer-to-peer reviews, writing appeal letters, and patient counseling over the 6-month period, in total averaging 3.6 0.5 hours per patient. 2003; 349:768775. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). 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. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. JAMA. Your insurance might have a requirement about length of time in care with them, or degree level. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 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. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Are there transgender advocacy groups? She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. https://links.lww.com/PRSGO/B648.). Location: Bangkok, Thailand. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. 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 There are a few limitations in this study that deserve mention. 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. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. The generalizability of the findings presented here is limited by state laws. Now you will be denied! Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. 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. Lastly, FFS coverage also allows for inclusion of technologies, such as virtual modeling and surgical planning, which may be cost prohibitive in self-pay patients despite evidence that accuracy is improved.10,11. Please read a few important elements consider when booking. 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. Leigh JP, Tancredi D, Jerant A, et al. 3. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Plast Reconstr Surg. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Transgender women may choose FFS as part of their male-to-female transition process. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. ENQUIRE NOW. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Please note that before you can schedule . Both of these methods are. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. 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*,. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). information about insurance coverage: video.transcendlegal.org 2. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. A letter from your primary care provider or whoever prescribes your hormones. Please try again soon. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Wolters Kluwer Health, Inc. All rights reserved. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Please first read this resource for a general overview of insurance utilization for trans surgery. 4. Co-insurance past that? This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Facial feminization surgery: the forehead. 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. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 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. Only if your insurance provider authorizes a Letter of Agreement. When it comes to facial feminization there is no substitute for experience. The doctor said very encouraging. 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Read this first. 15. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 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. 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. Facial Feminization Surgery: A Guide for the Transgendered Woman. Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. Dr. Thomas Satterwhite Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. 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). If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. 3). 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. This is their communication with the insurance company verifying that the procedure is covered. Months required for definitive insurance authorization decisions for FFS. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 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. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy.