Denver Health to Offer Facial Feminization Gender Confirmation Surgery Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. *. Frequently Asked Questions | Facial Feminization Surgery | Dr Keojampa You may be trying to access this site from a secured browser on the server. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Every insurance company is "difficult" to work with. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Research that Matters. ENQUIRE NOW. Only patients with insurance authorization decisions were included in this study (n = 40). 2016; 137:438448. Call 913-588-6200 to request a consultation. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. 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. 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. Facial Feminization Miami | The Maercks Institute 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. 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. Bottom Surgery: Cost, Recovery, Procedure Details, and More - Healthline ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 3. 3). Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. 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. Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Using Insurance for Facial Gender Confirming Surgery or "FFS" Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Facial Feminization Surgery (FFS) | University of Miami Health System 2. Read on to find out why you might pay more or less, and whether the cost is really worth it. See all insurance information. 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. Gender-Affirming Surgery Information - East Bay In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. 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. JAMA. 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. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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 Surgery FFS Insurance Coverage 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. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. Dr. Freet accepts both insurance and Medicare. 2010; 170:17281734. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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? Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. Rhinoplasty. The administrator hourly compensation set at our institution was used for the cost analysis. Post Surgery Recovery. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. James S, Herman J, Rankin S, et al. Gender Affirmation Surgery - University of Utah Padula WV, Heru S, Campbell JD. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Plastic and Cosmetic Surgery. Facial Feminization Surgery (FFS) | Johns Hopkins Medicine One of the major issues among surgeons and patients with regard to insurance coverage for FFS is the lack of understanding of the process as coverage for gender healthcare is highly variable depending on state law and plan variabilities (Table 3). 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. Body-contouring. 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 . may email you for journal alerts and information, but is committed A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. Total Staff: 34. This process will be long and draining, but it is worth it. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Private insurances included health maintenance organizations and preferred provider organization. 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. Among the 26 patients (65.0%) who underwent the standard approval process, 13 patients had Medi-Cal, 4 patients had Medicare, and 9 patients had private insurance. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado 5. For people without local connections, the facebook group, " FFS Facial Feminization Surgery / Transgender TG TS " and the FFS Forums on susans.org are good places to seek community support as well. We have a dedicated Insurance Advocacy Team that handles the entire process of insurance approval for patients; we send all your documents to your insurance providers and work with them to try and secure coverage to the fullest extent. The total time from initial consultation to definitive authorization decision for Group A was 1.1 0.2 months (Fig. 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). Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Male-to-female (MTF) facial feminization. As with any surgical procedure, there are risks associated with FFS. 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. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Facial Feminization in Korea - Everything You Need to Know! It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. 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. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Plast Reconstr Surg. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Facial feminization aims to find balance and harmony of the face between shadow and light, masculine and feminine, natural aging and youthfulness. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. 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. Leigh JP, Tancredi D, Jerant A, et al. Health insurance might not cover surgical procedures considered cosmetic for the cisgender population people whose gender identity matches the one they were assigned at birth even though these procedures are . You will be asked to complete an intake questionnaire before your consultation. Gender-Affirming Surgery: Original Article. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. 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. Lastly, a third subgroup of patients (Group C), all with private insurance, were denied for surgery despite multi-level appeals, peer-to-peer discussions, and IMR. Submission and review of initial authorization request (1 month); 2. Look here for licensed dentists practicing in the state. 6. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Error bars denote standard error. Prior to meeting with the social worker, patients should complete this assessment document. Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. The work cannot be changed in any way or used commercially without permission from the journal. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. Transgender women may choose FFS as part of their male-to-female transition process. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. 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. 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. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. Feminizing surgery - Mayo Clinic Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Find a Surgeon for Gender Affirming Surgery - TransHealthCare 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. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. For more information, please refer to our Privacy Policy. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. The Case For Facial Feminization Surgery - BuzzFeed News Letters - Crane Center for Transgender Surgery We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. This could be a good time to join (or form!) No. Facial Feminization Surgeons - Gender-Affirming FFS Surgeons 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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Bariatric Surgery. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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. 7. I am working from the perspective that you are unable to pay in full and be reimbursed. 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. Facial Feminization Surgery | Michigan Medicine - U of M Health 1. Descriptive statistics were performed for demographic variables. Schedule surgery 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. 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. 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. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy.