Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. Please first read this resource for a general overview of insurance utilization for trans surgery. 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. 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. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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. 1. information about insurance coverage: video.transcendlegal.org 2. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. 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. 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. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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 second level, patient-initiated appeal (1 month); 4. Surgical techniques and analysis of results. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. 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. (link is external) for CGSP. The doctor said very encouraging. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Dr. Thomas Satterwhite Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Get a bossy friend to make phone calls with you while you are dealing with the process. I always advise people to try with the insurance they have before they switch to another plan. 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. FHS/FFS (Facial Harmonization Surgery / Facial Feminization Surgery) Metoidioplasty/Phalloplasty Vaginoplasty/Vulvoplasty Classes cover the following material: Surgical options and techniques Surgery planning and pathway at Kaiser Post-operative care and recovery Most sessions also include a patient panel 3. This is the point at which you will likely need legal support. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Transgender women may choose FFS as part of their male-to-female transition process. All patients with public insurance (Medi-Cal or Medicare) as well as a small subset of private insurance plans were approved after initial submission of authorization request or did not require approval before surgery (Medicare) (Fig. 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. While facial feminization surgery has many potential benefits, the decision to proceed . 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. Ann Plast Surg. 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. Facial Reconstruction: Gender affirming facial surgery is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age; and Thus, coverage significantly increases accessibility. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. to maintaining your privacy and will not share your personal information without
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. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. 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. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. The analysis was done by identifying individual steps involved in the insurance process (Fig. In this work, we detailed our institutional experience on obtaining insurance coverage for 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. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming 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. As an example, the typical timeline for our Group B and C patients is as follows: 1. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 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.) 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. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. 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. 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. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. 3. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Research that Matters. If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. 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. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Brow Lift. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Want to use our data? The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. This is called facial feminization surgery. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. *. Historically, FFS hasn't been covered by health insurance or government healthcare. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. According to the Philadelphia Center for Transgender Surgery,. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Our team will help you set up a MyChart account where you will have the ability to fill this out online. 2020 Deschamps-braly clinic. These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. Ask to speak to people's supervisors. The administrator hourly compensation set at our institution was used for the cost analysis. Notes. 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. Facial Feminization Surgery: A Guide for the Transgendered Woman. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage 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. 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. 2015; 136:560e561e. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 2. 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. 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. 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. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. Location: Bangkok, Thailand. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. $8995. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. 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. They submit their own information, information about the procedure being performed, and information about you. 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. 1). Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 8. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. 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. ENQUIRE NOW. 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? 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. Have your facial features compromised your safety, making you a target for harassment and violence? 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. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. Qual Life Res. 7. surgical techniques and analysis of results. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. 2018; 153:609616. 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. 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 . https://links.lww.com/PRSGO/B647.). Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Read more. Wolters Kluwer Health
Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine.