ffs surgeons who take insurance

As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. 1. surgical techniques and analysis of results. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Group A (standard approval) included patients who were approved after undergoing a standard authorization process, such as those with Medi-Cal, Medicare, and private insurance. 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. Canner JK, Harfouch O, Kodadek LM, et al. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. 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. 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. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. 15. to maintaining your privacy and will not share your personal information without 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. The analysis was done by identifying individual steps involved in the insurance process (Fig. If performed all at once, FFS usually takes between 4- 8 hours. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. During Your FFS Procedure How long it takes: This depends on what you are having done. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. While facial feminization surgery has many potential benefits, the decision to proceed . The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Braun TL, Braun JL, Hernandez C, et al. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Plast Reconstr Surg. Dr. Freet accepts both insurance and Medicare. 2010; 19:10191024. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. 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). If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Plast Reconstr Surg. 3). This process will be long and draining, but it is worth it. 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. Integral to this whole process is the FGCS surgeon. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 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. KP FFS Surgeons. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Thus, coverage significantly increases accessibility. https://links.lww.com/PRSGO/B648.). We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. 2018; 153:609616. N Engl J Med. Health insurance might not cover surgical procedures considered cosmetic for the cisgender population people whose gender identity matches the one they were assigned at birth even though these procedures are . https://links.lww.com/PRSGO/B648.) 2. Some of the procedures included in facial feminization surgery are: Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. They submit their own information, information about the procedure being performed, and information about you. Third, full-face, one-stage FFS is a highly time-consuming surgery due to the multiple anatomical areas addressed at once (averaging 8.5 hours in the senior authors experience). Facial feminization surgery: the forehead. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 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. Patients were stratified into 3 groups by authorization process. 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. 2019; 144:11591168. Tate, who has been with Starbucks for 15 years and now manages a store in Austin, Texas, is one of a growing number of Starbucks partners who have used the company's leading-edge benefits for transgender partners. Tseng P, Kaplan RS, Richman BD, et al. An estimated 90% of all patient consults were approved for FFS under insurance. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. James S, Herman J, Rankin S, et al. Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. Prior to meeting with the social worker, patients should complete this assessment document. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? The United States . For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. After a person pays the deductible, Medicare pays 80% of the allowable costs . 2). 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. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. 10. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Lastly, a third subgroup of patients (Group C), all with private insurance, were denied for surgery despite multi-level appeals, peer-to-peer discussions, and IMR. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. This is also the point at which general 201 level guidance ceases to be useful. 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. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Second, while complications are not high in FFS, they may occur. Post Surgery Recovery. 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. Private insurances included health maintenance organizations and preferred provider organization. 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. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. Padula WV, Heru S, Campbell JD. Conveniently Located to Serve Chicago and Illinois. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. You should be able to have easy access to this document through your insurance provider. Do you have a deductible to meet? From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. 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. 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. This should be sent to you in written form, with the specific reason for the denial included. 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. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. The administrator hourly compensation set at our institution was used for the cost analysis. Every insurance company is "difficult" to work with. 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. 2). 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. These delicate procedures change the male facial patterns to a softer, feminine appearance. 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. Costs of health care administration in the United States and Canada. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. 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. 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 A total of 36 patients (90.0%) have been approved by insurance. Complete New Patient Questionnaire. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Submission and review of physician-initiated appeal (1 month); 3. I don't philosophically agree with this. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . 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. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). Policy Title: Gender Affirming Surgery. 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.). How soon can I book a surgery date? Woolhandler S, Campbell T, Himmelstein DU. The work cannot be changed in any way or used commercially without permission from the journal. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Do you have out of network benefits, or are you limited to providers in the network? 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. In addition, many of them don't take insurance. Research that Matters. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Furthermore, revisions may be indicated in some patients over time. 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. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 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. This is their communication with the insurance company verifying that the procedure is covered. Plastic surgery on the face. 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. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Descriptive statistics were performed for demographic variables. 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. 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. Read on to find out why you might pay more or less, and whether the cost is really worth it. Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . 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. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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. 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. For more information, please refer to our Privacy Policy. 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. Upon denial, an IMR is requested directly from the insurance plan. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Wolters Kluwer Health, Inc. All rights reserved. Read more. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 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. 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. School-Based Dental Sealants; Licensed Rhode Island Dentists. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. These procedures may include: Tummy tuck, called abdominoplasty. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Are there transgender advocacy groups? Care Credit approval amounts can vary from person to person. Only if your insurance provider authorizes a Letter of Agreement. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Facial Feminization Surgery: A Guide for the Transgendered Woman. 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. However, the cost can range from $1,847 to $62,000, depending on a few key factors. 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. 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. $4985. Estimated costs of obtaining insurance approval for FFS (B). Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. 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. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 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. Facial feminization surgery: the forehead. 2014; 134:609619. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. 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. 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. Requires supporting documentation that indicates specific type of FFS procedures requested. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Hoang H, Bertrand AA, Hu AC, et al. Justine C. Lee, MD, PhD, FACS, University of California, Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960, E-mail: [emailprotected]. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. We can't guarantee insurance coverage but we can guarantee to try our hardest! Try your local trans advocacy groups, LGBTI legal services, support group, etc. Plast Reconstr Surg Glob Open. 2015; 136:560e561e. Facial Feminization Surgery (FFS) is a group of facial procedures that alter the face to create more classically feminine characteristics, such as a higher brow, a more refined feminine nose, and less pronounced Adams apple. 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. In fact, he is one of the most experienced gender surgeons in the world. Finally, you should have an idea of your local resources. 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. 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.