What's your out of pocket max? Until then, CCTS will continue to require all patients using insurance for .
Gender-Affirmation Surgery | Transgender Surgery | The University of 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. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 3. Qual Life Res. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you.
FFS: paying and picking a surgeon. Freaking out and need advice. Wolters Kluwer Health, Inc. All rights reserved. A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). 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. 2014; 134:609619. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. 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 Please first read this resource for a general overview of insurance utilization for trans surgery. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. The objective is to soften the facial . The format for an appeals process and regulations/law/policy to cite within it vary widely depending on the mix of state and local regulations that apply to your specific plan. Submission and review of IMR (1 month). 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. surgical techniques and analysis of results. 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. 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. 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. 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. See all insurance information. Your insurance might have a requirement about length of time in care with them, or degree level. KP FFS Surgeons. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. Every insurance company is "difficult" to work with. HB2084 (2016) bans gender identity discrimination in health insurance and HB2405 (2022) bans categorical exclusions for gender-affirming care under any health plan, though the law does not . (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Now you will be denied! Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Facial feminization surgery can be covered by health insurance in some instances.
Facial Feminization Surgery - A Complete Guide to FFS - DESCHAMPS-BRALY Doximity. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. ENQUIRE NOW. Only patients with insurance authorization decisions were included in this study (n = 40). Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 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. Months required for definitive insurance authorization decisions for FFS. 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. Their credential as an MD/DO/NP/PA/MSW/PHD and signature on an essentially form WPATH conforming letter are not sufficient- they need to impress upon the medical reviewers that they are not simply approving your referral request, but are guiding your care as a treating provider, and that this surgery is part of your care plan. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 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. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 1). Get a bossy friend to make phone calls with you while you are dealing with the process. Average months spent from initial facial feminization consultation to final insurance authorization decision. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 8. Body-contouring. 2018; 153:609616. Call 913-588-6200 to request a consultation. 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. However, California state law stipulates gender non-discrimination in health insurance, thus, Medi-Cal covers all procedures performed specifically for the purposes of gender affirmation. 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).
Denver Health to Offer Facial Feminization Gender Confirmation Surgery Plast Reconstr Surg. Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. A total of 36 patients (90.0%) have been approved by insurance. Co-insurance past that? This is their communication with the insurance company verifying that the procedure is covered. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Out-of-pocket costs for FFS. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements.
Find Dental Health Services: Department of Health - Rhode Island James S, Herman J, Rankin S, et al. 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. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. Gray R, Nguyen K, Lee JC, et al. Submission and review of physician-initiated appeal (1 month); 3. 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]. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. In contrast to Group A, patients who required significant efforts in the form of multi-level appeals, peer-to-peer reviews, and IMRs were designated Groups B and C, depending on ultimate approval versus denial as the outcomes, respectively. 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. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. In fact, he is one of the most experienced gender surgeons in the world. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. 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.
FFS: money and choosing a surgeon : r/Transgender_Surgeries 14. This could be a good time to join (or form!) On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 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. 10. 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.) Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. 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. The administrator hourly compensation set at our institution was used for the cost analysis. 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.
Facial Feminization Surgery (FFS) in Mexico - MyMediTravel Location: Bangkok, Thailand. Some error has occurred while processing your request. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Dr. 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. 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. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Complete New Patient Questionnaire. 1. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Facial feminization surgery (FFS): The permanent . The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval.
Gender-Affirming Surgery Information - East Bay However, the cost can range from $1,847 to $62,000, depending on a few key factors. 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. 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. 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. Requires supporting documentation that indicates specific type of FFS procedures requested. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 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. In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. Ousterhout DK. (link is external) for CGSP. When it comes to facial feminization there is no substitute for experience. Costs of health care administration in the United States and Canada. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars.
Feminizing surgery - Mayo Clinic Insurance Requirements for Gender Confirmation Surgery - Verywell Health Facial Feminization Surgery FFS Insurance Coverage Choose from multiple implant types and sizes. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. 2018. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. 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. your express consent. 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. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons.
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