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Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Physician wages across specialties: informing the physician reimbursement debate. 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. 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. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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. Read this first. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 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. Plast Reconstr Surg. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Your insurance might have a requirement about length of time in care with them, or degree level. Wolters Kluwer Health, Inc. All rights reserved. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Please first read this resource for a general overview of insurance utilization for trans surgery. Read more about our Clinics Finance and Insurance Policy here. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. If they are a member of WPATH or other applicable professional associations, they should name that. JCL is additionally supported by the US Department of Veterans Affairs under award number IK2 BX002442 and the National Institutes of Health/NIDCR R01 DE0289098. It involves plastic surgery techniques in which the jaw, chin, cheeks, forehead, nose, and areas surrounding the eyes, ears or lips are changed to create a more feminine appearance. 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. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. See all insurance information. 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. 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. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. 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. Location: Bangkok, Thailand. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. 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. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. This could be a good time to join (or form!) Furthermore, revisions may be indicated in some patients over time. Male-to-female (MTF) facial feminization. Data is temporarily unavailable. 7. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. 1. 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. A total of 36 patients (90.0%) have been approved by insurance. School-Based Dental Sealants; Licensed Rhode Island Dentists. 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. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. 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. 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. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. 3). Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Rhinoplasty. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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. This means that the surgeon is either already in network with your insurance and is willing to send a prior authorization, or has an office willing to do the legwork of doing a letter of agreement with your insurance. Submission and review of second level, patient-initiated appeal (1 month); 4. Canner JK, Harfouch O, Kodadek LM, et al. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. 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.) Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. 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. Descriptive statistics were performed for demographic variables. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Submission and review of physician-initiated appeal (1 month); 3. Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 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. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. 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. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Arch Intern Med. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . 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 Group C authorization process, which resulted in denial of services, consumed a 9-fold higher amount of time (P < 0.001) and 26-fold higher cost (P < 0.001) when compared with Group A (Fig. 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. The doctor said very encouraging. 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]. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS.

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