ffs surgeons who take insurance
-ffs surgeons who take insurance
2019; 144:11591168. According to the Philadelphia Center for Transgender Surgery,. Look here for licensed dentists practicing in the state. 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. J Gen Intern Med. 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. 6. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. may email you for journal alerts and information, but is committed Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. Upon denial, an IMR is requested directly from the insurance plan. Everyone who is able to fight through it cracks the door open a little wider for the next person. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. We hope our in-person consultation will answer all of your questions, provide your sense of confidence and also further your excitement of the path you are on. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? If they are a member of WPATH or other applicable professional associations, they should name that. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Please try after some time. 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. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. 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. Physician wages across specialties: informing the physician reimbursement debate. School-Based Dental Sealants; Licensed Rhode Island Dentists. In the rare instance that FFS Surgery is included in your health insurance policy, services may be incomplete or function only on a reimbursement basis. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Plast Reconstr Surg. 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. 2020; 8:e2618. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. 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. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. 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. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. 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. Simplifying facial feminization surgery using virtual modeling on the female skull. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. In contrast, FFS under insurance coverage allows for inpatient care, which may be important, particularly to surgeon decision-making as well as patients who may have other medical conditions, pain control issues, or those who travel from long distances. A letter from your primary care provider or whoever prescribes your hormones. 2018; 153:609616. Submission and review of physician-initiated appeal (1 month); 3. 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). We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Arch Intern Med. 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. Get a bossy friend to make phone calls with you while you are dealing with the process. Historically, FFS hasn't been covered by health insurance or government healthcare. 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. Among the total cohort, most patients had private insurance (n = 23, 57.5%), followed by Medi-Cal (n = 13, 32.5%), and Medicare (n = 4, 10.0%). 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. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. . The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). James S, Herman J, Rankin S, et al. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Private insurances included health maintenance organizations and preferred provider organization. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Your scars may take up to a year to heal. Days, whose birth name was Douglas, came out as transgender in January, 2015. 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. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. 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 . Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Price (USD) Forehead Recontouring. Surgical techniques and analysis of results. 6. Integral to this whole process is the FGCS surgeon. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. 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. 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. They submit their own information, information about the procedure being performed, and information about you. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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. Both of these methods are. Read this first. We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). 11. Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. These delicate procedures change the male facial patterns to a softer, feminine appearance. I am working from the perspective that you are unable to pay in full and be reimbursed. I don't philosophically agree with this. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. 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. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 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. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Submission and review of initial authorization request (1 month); 2. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Choose from multiple implant types and sizes. 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 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. This process will be long and draining, but it is worth it. Ann Plast Surg. Ask to speak to people's supervisors. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Facial feminization surgery: the forehead. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. This is also the point at which general 201 level guidance ceases to be useful. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 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). 2018. 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. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. 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. It's an attempt to make the face as attractive as possible for as long as it lasts. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. 12. Facial Feminization Surgery: A Guide for the Transgendered Woman. 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. Facial feminization surgery (FFS) uses a series of procedures to alter features to appear more classically female. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. What's your out of pocket max? Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). 3). This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. https://links.lww.com/PRSGO/B648.). 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. 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. $8995. 3). (link is external) for CGSP. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. Months required for definitive insurance authorization decisions for FFS. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). 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. These procedures may include: Tummy tuck, called abdominoplasty. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). This might be the hardest part- no one should have to compromise quality, and the big names in FGCS have historically not taken insurance, though its my observation that this is rapidly changing. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Only patients with insurance authorization decisions were included in this study (n = 40). 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. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. 1. Call 913-588-6200 to request a consultation. We can't guarantee insurance coverage but we can guarantee to try our hardest! The doctor said very encouraging. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. 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. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. Requires supporting documentation that indicates specific type of FFS procedures requested. Our current work highlights the high likelihood of success in FFS coverage under insurance in California, but also details the challenges that plastic surgeons and plastic surgery practices incur for coverage to occur. $4985. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Your insurance might have a requirement about length of time in care with them, or degree level. 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. Gender-Affirming Surgery: Original Article. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Policy Issued By: Anthem. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. The report of the 2015 U.S. transgender survey. From the cohort, 3 subgroups were delineated. 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. 3. Facial feminization surgery (FFS): The permanent . Dr. Thomas Satterwhite Canner JK, Harfouch O, Kodadek LM, et al. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. 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. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Facial Feminization Surgery (FFS) Preparation Guide. Available at: 2. You may be trying to access this site from a secured browser on the server. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. An estimated 90% of all patient consults were approved for FFS under insurance. 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. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Procedure. Second, while complications are not high in FFS, they may occur. Dr. Andrew Kleinberger. 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. 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. Support groups? Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. You will be asked to complete an intake questionnaire before your consultation. Read more. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). This could be a good time to join (or form!) I always advise people to try with the insurance they have before they switch to another plan. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. 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. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Submission and review of IMR (1 month). 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. 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). 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. 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. 2003; 349:768775. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. your express consent. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Each patient is different and your expectations and desired results will be discussed fully in your consultation. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. 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. How soon can I book a surgery date? However, this has been a persuasive strategy in some cases. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. 2015; 136:560e561e. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. While facial feminization surgery has many potential benefits, the decision to proceed . Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. 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. Rhinoplasty. Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist). Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. Received for publication February 2, 2021; accepted February 27, 2021. Plastic and Cosmetic Surgery. 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. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 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. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . One of the major barriers for transgender patients is accessibility to gender-affirming surgeries due to the lack of insurance coverage or inability to afford surgery as a self-pay patient.1 In an analysis of the National Inpatient Sample, Canner and colleagues noted that between 2000 and 2014, 56.3% of patients undergoing gender-affirming surgery were not covered by any health insurance plan.2 Over the course of this period, particularly between 2012 and 2014, an increase in patients covered by private insurance and Medicare and Medicaid was noted.