FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. 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. 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. Get a bossy friend to make phone calls with you while you are dealing with the process. 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 it is substantial, they should name their years of experience working with transgender patients. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. $8995. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Arch Intern Med. 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. 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. 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 is more often referred to as "gender reaffirmation surgery", and is performed on . Available at: 9. Both of these methods are. Received for publication February 2, 2021; accepted February 27, 2021. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 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. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. 2010; 170:17281734. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. $8995. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. 13. Data is temporarily unavailable. 2020; 8:e2618. Gender-Affirming Surgery: Original Article. 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. 2014; 134:609619. Please read a few important elements consider when booking. Facial Feminization Surgery (FFS) Preparation Guide. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. $4985. 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. 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. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. Additionally, planning and recovering from any trans surgery is hard! 2). Brow Lift. 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. Until then, CCTS will continue to require all patients using insurance for . This is the point at which you will likely need legal support. 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). 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. I am working from the perspective that you are unable to pay in full and be reimbursed. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Insurance Coverage for FFS Surgery abroad Medical inequality for trans people means that access to quality trans healthcare is absent or limited in many regions. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Ask them how many FFS surgeries they perform within a year. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. 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. Days, a 50-year-old Berkeley resident, had just returned from a month-long trip to Spain in February, where she underwent a procedure known as facial feminization surgery, or FFS. 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. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. 2). Dr. Ellie Zara Ley, MD is an accomplished board-certified plastic surgeon who had more than 15 years of specialized training in plastic, craniofacial and micro surgery before learning the art of Gender Confirmation 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. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. The benefits of such coverage far exceed the insignificant costs. His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. Do you have a deductible to meet? 3. 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. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. FGCS is a treatment for gender dysphoria related to the secondary sex characteristics in the face, not a treatment for anxiety caused by the experience of having gender dysphoria or being a transgender person in an unkind world. As an example, the typical timeline for our Group B and C patients is as follows: 1. 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. 12. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Please first read this resource for a general overview of insurance utilization for trans surgery. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. 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. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 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. *, Time and cost of the insurance approval process for FFS. Have your facial features compromised your safety, making you a target for harassment and violence? Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. Among the various gender-affirming procedures, facial feminization surgery (FFS) is arguably the most commonly denied surgery, as insurance companies often deem the involved procedures as cosmetic and not medically necessary. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. Do you have out of network benefits, or are you limited to providers in the network? Ann Plast Surg. Read more about our Clinics Finance and Insurance Policy here. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. James S, Herman J, Rankin S, et al. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. Otherwise, your deposit will be applied towards your surgical balance. Policy Title: Gender Affirming Surgery. This could be replaced with language about how you are not eligible to take estrogen therapy for whatever reason, including fancy language for just not wanting to. Dr. Thomas Satterwhite For example, there are now many hospitals across the . 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. Plastic and Cosmetic Surgery. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. I don't philosophically agree with this. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Start with ensuring that you have an in-depth understanding of your insurance benefits. 6. 10. Plast Reconstr Surg Glob Open. surgical techniques and analysis of results. Available at: 2. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. Every insurance company is "difficult" to work with. Care Credit approval amounts can vary from person to person. Days, whose birth name was Douglas, came out as transgender in January, 2015. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Integral to this whole process is the FGCS surgeon. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. You will be asked to complete an intake questionnaire before your consultation. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. This is called facial feminization surgery. Out-of-pocket costs for FFS. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. 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. How soon can I book a surgery date? Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Finally, you should have an idea of your local resources. The administrator hourly compensation set at our institution was used for the cost analysis. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Please enable scripts and reload this page. 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. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Patients were stratified into 3 groups by authorization process. The report of the 2015 U.S. transgender survey. 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. However, the cost can range from $1,847 to $62,000, depending on a few key factors. I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. https://links.lww.com/PRSGO/B648.). Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 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? This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 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. 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. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Facial feminization surgery: the forehead. Modeling performed by Padula and colleagues for employer-based insurance plans in Massachusetts indicated that, over the course of 5 years, coverage for transition-related services would lead to societal costs of $0.016 per month per member.3 The authors concluded that the relatively low societal cost, combined with the increase in quality-adjusted life years for transgender patients, supported coverage of transition-related services in employer-based plans. During Your FFS Procedure How long it takes: This depends on what you are having done. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 3). 7. You should be able to have easy access to this document through your insurance provider. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. N Engl J Med. However, some insurers are beginning to cover FFS from select surgeons. I always advise people to try with the insurance they have before they switch to another plan. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Facial feminization surgery (FFS): The permanent . (link is external) for CGSP. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. The generalizability of the findings presented here is limited by state laws. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 2). Two letters from mental health providers. In practice for more than 20 years, Dr. Salgado performs all aspects of transgender surgeries, from Facial Feminization and Top Surgery, to complex genital procedures such as Vaginoplasty and Phalloplasty. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 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. ENQUIRE NOW. 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. We can't guarantee insurance coverage but we can guarantee to try our hardest! 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.