Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 2019; 144:11591168. surgical techniques and analysis of results. 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. Upon denial, an IMR is requested directly from the insurance plan. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Facial feminization surgery can be covered by health insurance in some instances. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . 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. 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. https://links.lww.com/PRSGO/B648.). Capitn L, Simon D, Kaye K, et al. 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. Dr. KathleynBrandstetter. 2010; 170:17281734. 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. See all insurance information. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. 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. 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. Beginning in June 2021, Dr. Esmonde will serve as a full-time Associate Surgeon with The Meltzer Clinic offering the full spectrum of gender-affirming procedures. 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.) These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Surgical techniques and analysis of results. J Gen Intern Med. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. 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. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. They accept most major insurances and work to help you get your surgery fully covered whenever possible. Privacy Policy (Updated December 15, 2022). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. 10. A total of 36 patients (90.0%) have been approved by insurance. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Some of the procedures included in facial feminization surgery are: A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? During Your FFS Procedure How long it takes: This depends on what you are having done. Submission and review of initial authorization request (1 month); 2. Care Credit approval amounts can vary from person to person. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Each patient is different and your expectations and desired results will be discussed fully in your consultation. 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). 3). 3). 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. For more information, please refer to our Privacy Policy. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Generally, one provider should have a doctoral level degree (PhD, DSW, Psychiatrist MD) and the other can have a masters level degree (MSW, MHC, etc.) Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. 15. 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). Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 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. Your message has been successfully sent to your colleague. Integral to this whole process is the FGCS surgeon. 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. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. 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. 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. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. 2018; 153:609616. information about insurance coverage: video.transcendlegal.org 2. 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 Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. 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). 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. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Dr. Facque joined the Gender Confirmation Centers team in September 2020 as a full-time Associate Surgeon specializing in Facial Gender Confirmation Surgery, Top Surgery and Body Contouring. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. 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. 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. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. There are a few limitations in this study that deserve mention. 12. These procedures may include: Tummy tuck, called abdominoplasty. Procedure. Although your FFS may not be covered by your insurance company its definitely worth doing the research. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Woolhandler S, Campbell T, Himmelstein DU. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation 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. Every state is different so start with Google and reach out to these services in your state, theyre here for you! In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. P < 0.05 was considered significant. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Physician wages across specialties: informing the physician reimbursement debate. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery.