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Complete New Patient Questionnaire. Facial Feminization Surgery, FFS Minneapolis and - Omni Cosmetic This is called facial feminization surgery. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Facial feminization surgery can be covered by health insurance in some instances. 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). Schedule surgery Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. 2020 Deschamps-braly clinic. PDF Gender Confirming/Grs Surgeon List and Resources for Preparing for Surgery Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. This is also the point at which general 201 level guidance ceases to be useful. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. 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. JAMA Surg. If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Thus, coverage significantly increases accessibility. Transgender people report years of battles for health insurance coverage 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. Arch Intern Med. They submit their own information, information about the procedure being performed, and information about you. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures, including Top Surgery, Phalloplasty, Vaginoplasty and Facial Feminization Surgery. 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. Transgender women may choose FFS as part of their male-to-female transition process. 14. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Descriptive statistics were performed for demographic variables. 12. 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. 4. Facial Feminisation Surgery | Nuffield Health There are a few limitations in this study that deserve mention. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . FFS: money and choosing a surgeon : r/Transgender_Surgeries Plast Reconstr Surg Glob Open. to maintaining your privacy and will not share your personal information without Otherwise, your deposit will be applied towards your surgical balance. Submission and review of physician-initiated appeal (1 month); 3. Plastic surgery on the face. 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. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. 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. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. The United States . 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 The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. All rights reserved. Gender-Affirming Surgery: Original Article. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Support groups? Gender-Affirmation Surgery | Transgender Surgery | The University of Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. Best FFS Surgeons: What to Know and Where to Go Facialteam They accept most major insurances and work to help you get your surgery fully covered whenever possible. 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. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. There are 301 level topics not covered here- going out of network to an office who will only give you CPT codes performed, getting a network exception to go to a provider with skills not available among in-network surgeons, etc. 1. Wolters Kluwer Health For more information, please refer to our Privacy Policy. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Integral to this whole process is the FGCS surgeon. Want to use our data? Price (USD) Forehead Recontouring. Insurance and facial feminization surgery - 2pass Clinic 2. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Cost of Facial Feminization Surgery (FFS) and Insurance Information Finding a Surgeon Integral to this whole process is the FGCS surgeon. https://links.lww.com/PRSGO/B647.). Temporal trends in gender-affirming surgery among transgender patients in the United States. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. $8995. As an example, the typical timeline for our Group B and C patients is as follows: 1. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Best Rated Facial Feminization Surgeon (FFS) in the World 2010; 170:17281734. 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. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Brow Lift. Facial Feminization in Korea - Everything You Need to Know! Thus, coverage significantly increases accessibility. Physician wages across specialties: informing the physician reimbursement debate. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 1. 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. 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. 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. You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). Doctors and nurses take good care. We can't guarantee insurance coverage but we can guarantee to try our hardest! surgical techniques and analysis of results. 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. 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. Gender Affirmation Surgery - University of Utah 11. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Co-insurance past that? Facial Feminization Surgery: FFS Surgery in Thailand Additionally, planning and recovering from any trans surgery is hard! We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. You may be trying to access this site from a secured browser on the server. Facial feminization surgery: the forehead. Do you have out of network benefits, or are you limited to providers in the network? 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*,. 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. 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. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Dr. After a person pays the deductible, Medicare pays 80% of the allowable costs . (link is external) for CGSP. https://links.lww.com/PRSGO/B648.). Start with ensuring that you have an in-depth understanding of your insurance benefits. 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Months required for definitive insurance authorization decisions for FFS. Facial feminization surgery: the forehead. 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. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Privacy Policy (Updated December 15, 2022). In addition, many of them don't take insurance. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. If they are a member of WPATH or other applicable professional associations, they should name that. Only if your insurance provider authorizes a Letter of Agreement. Some of the procedures included in facial feminization surgery are: 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. Historically, FFS hasn't been covered by health insurance or government healthcare. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. 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. 1. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Gender Affirming Surgery - Medical Clinical Policy Bulletins - Aetna Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Feminizing surgery - Mayo Clinic Starbucks offers expanded benefits for trans people Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. 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. If it is substantial, they should name their years of experience working with transgender patients. Insurance - International Center for Transgender Care Error bars denote standard error. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Policy Title: Gender Affirming Surgery. Every state is different so start with Google and reach out to these services in your state, theyre here for you! The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. 6. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. FFS: paying and picking a surgeon. Freaking out and need advice. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. 2016; 31:394401. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Submission and review of initial authorization request (1 month); 2. However, some insurers are beginning to cover FFS from select surgeons. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. 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). Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. $8995. Post Surgery Recovery. 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. Jess Ting - Plastic and Reconstructive Surgery - Mount Sinai Health System Facial Feminization | Dr. Patel Chicago | MTF Facial Plastic Surgery 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. Dr. Freet accepts both insurance and Medicare. Facial Feminization Surgery - Costs - What does FFS cost? - 2pass Clinic Now you will be denied! 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. Out-of-pocket costs for FFS. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Everyone who is able to fight through it cracks the door open a little wider for the next person. Simplifying facial feminization surgery using virtual modeling on the female skull. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. The concept and treatments were developed with transfeminine patients in mind in the 1980s, led by a San Francisco-based surgeon who devised measurements for a "normal" female appearance by surveying anthropological skeletal records. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. N Engl J Med. 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. 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. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 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. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. 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. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. For Bay Area trans women, facial feminization surgery helps complete On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. 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. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 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. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. James S, Herman J, Rankin S, et al. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Among the total cohort, most patients had private insurance (n = 23, 57.5%), followed by Medi-Cal (n = 13, 32.5%), and Medicare (n = 4, 10.0%). Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. See all insurance information. Received for publication February 2, 2021; accepted February 27, 2021. There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Facial Feminization Surgery (FFS) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. 2020; 8:e2618. Ultimately this letter is between you and your provider, but here is some sample language that has been helpful to patients I've worked with: "Patient X has been adherent to two years of hormone replacement therapy including (specific estrogen regimen.) Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. 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. *, Time and cost of the insurance approval process for FFS. An estimated 90% of all patient consults were approved for FFS under insurance. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Leigh JP, Tancredi D, Jerant A, et al. Read this first. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Please read a few important elements consider when booking. 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. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. 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. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . 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. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons 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.