ffs surgeons who take insurance
Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Do you have a deductible to meet? We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. 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. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Qual Life Res. Please try again soon. 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. Finding a Surgeon Integral to this whole process is the FGCS surgeon. 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. 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). Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. 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. Plast Reconstr Surg. Total Staff: 34. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. 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. 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. Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Error bars denote standard error. 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. This should be sent to you in written form, with the specific reason for the denial included. A number of patients had multiple consultations, some consulted legal assistance, and, particularly patients in Groups B and C, some experienced significant distress over the repetitive denials and lack of clarity in the end result of the process. 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. Plast Reconstr Surg. As with any surgical procedure, there are risks associated with FFS. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. Complete New Patient Questionnaire. When it comes to facial feminization there is no substitute for experience. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. 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. 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. Until then, CCTS will continue to require all patients using insurance for . As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. A total of 36 patients (90.0%) have been approved by insurance. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. Look here for licensed dentists practicing in the state. Try your local trans advocacy groups, LGBTI legal services, support group, etc. 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). During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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. 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. 2018; 80:198204. 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. 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. The United States . Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Transgender women may choose FFS as part of their male-to-female transition process. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Read this first. We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. This is their communication with the insurance company verifying that the procedure is covered. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Out-of-pocket costs for FFS. Patients were stratified into 3 groups by authorization process. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Notes. Prior to meeting with the social worker, patients should complete this assessment document. 6. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Second, while complications are not high in FFS, they may occur. You may be trying to access this site from a secured browser on the server. 2). 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. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. 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. Do you have out of network benefits, or are you limited to providers in the network? 2020; 8:e2618. Otherwise, your deposit will be applied towards your surgical balance. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. 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. 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. Submission and review of initial authorization request (1 month); 2. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Please try after some time. Your insurance might have a requirement about length of time in care with them, or degree level. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. 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. your express consent. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. 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. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. 1. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . 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. Do you have access to out-of-network providers or in-network only. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Padula WV, Heru S, Campbell JD. Requested CPT codes are detailed in Supplemental Digital Content 1. 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. 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. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. From the cohort, 3 subgroups were delineated. Denial overturn was either mandated by the California Department of Managed Healthcare for California-insured plans or by the respective insurance companies for self-insured, employer-based plans under the Employee Retirement Income Security Act of 1974 (ERISA). Most other insurance plans do not cover FFS and consider it as cosmetic surgery. This is called facial feminization surgery. 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. This is also the point at which general 201 level guidance ceases to be useful. 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 . We can't guarantee insurance coverage but we can guarantee to try our hardest! Facial feminization surgery: the forehead. If they are a member of WPATH or other applicable professional associations, they should name that. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 2010; 170:17281734. Additionally, the patients who exited their employer-based plans to buy health insurance on the exchange paid more for health insurance by foregoing employer contributions. 2. 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). This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. 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. 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. They accept most major insurances and work to help you get your surgery fully covered whenever possible. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. You will be asked to complete an intake questionnaire before your consultation. Read more about our Clinics Finance and Insurance Policy here. *. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. 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. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. In the standard approval process (Group A), patients were under both public and certain private insurance plans (39% of all privately insured patients in the cohort). 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. 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. You should be able to have easy access to this document through your insurance provider. 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. 8. 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 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. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. 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. 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. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. 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. Your message has been successfully sent to your colleague. Two letters from mental health providers. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. 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. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 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. FFS is a cost-effective intervention that needs to be covered by insurance policies. 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]. . Research that Matters. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Dr. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). 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 an example, the typical timeline for our Group B and C patients is as follows: 1. 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. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Some of the procedures included in facial feminization surgery are: Every state is different so start with Google and reach out to these services in your state, theyre here for you! Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Only patients with insurance authorization decisions were included in this study (n = 40). Though WPATH has released the new SOC, it will take insurance companies time to evolve. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Descriptive statistics were performed for demographic variables. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Submission and review of second level, patient-initiated appeal (1 month); 4. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . P < 0.05 was considered significant. 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. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Wolters Kluwer Health, Inc. All rights reserved. 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. Policy Title: Gender Affirming Surgery. It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. They submit their own information, information about the procedure being performed, and information about you. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Please note that before you can schedule . Ask them how many FFS surgeries they perform within a year. may email you for journal alerts and information, but is committed 2020 Deschamps-braly clinic. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. The analysis was done by identifying individual steps involved in the insurance process (Fig. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. 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. Woolhandler S, Campbell T, Himmelstein DU. 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. James S, Herman J, Rankin S, et al. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. For patients anticipating insurance coverage for your surgery, we appreciate that you may wish to seek insurance reimbursement for the cost of some or all of your feminization procedures and have outlined some general guidelines below.