$8995. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. 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. Padula WV, Heru S, Campbell JD. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Policy Issued By: Anthem. Temporal trends in gender-affirming surgery among transgender patients in the United States. Qual Life Res. 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. 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? Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Dr. By browsing TransHealthCare.org, you consent to our use of cookies and other tracking technologies. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 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. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. The generalizability of the findings presented here is limited by state laws. 15. Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. See all insurance information. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. 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. Post Surgery Recovery. 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. James S, Herman J, Rankin S, et al. Surgical techniques and analysis of results. Bariatric Surgery. 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. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. In addition, many of them don't take insurance. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 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. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Facial Feminization Surgery: A Guide for the Transgendered Woman. Location: Bangkok, Thailand. 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). Disclosure: All the authors have no financial interest to declare in relation to the content of this article. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. JAMA Surg. 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. However, this is starting to change. surgical techniques and analysis of results. Complete New Patient Questionnaire. Ann Plast Surg. Dr. KathleynBrandstetter. 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. Submission and review of second level, patient-initiated appeal (1 month); 4. 2003; 349:768775. 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. 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. 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. You should be able to have easy access to this document through your insurance provider. Submission and review of physician-initiated appeal (1 month); 3. . Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. 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 Two letters from mental health providers. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. 2020 Deschamps-braly clinic. 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. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Choose from multiple implant types and sizes. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. 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. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 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. 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. Gray R, Nguyen K, Lee JC, et al. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Prior to meeting with the social worker, patients should complete this assessment document. 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. 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. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. 2010; 170:17281734. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Error bars denote standard error. 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. Male-to-female (MTF) facial feminization. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Call 913-588-6200 to request a consultation. 3. (link is external) for CGSP. Your insurance might have a requirement about length of time in care with them, or degree level. Policy Title: Gender Affirming Surgery. Each letter should state "this procedure is medically necessary treatment. With all letters, I advise providers to be as authoritative in their tone as possible, and to explicitly claim an expert status if appropriate. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. 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 Plast Reconstr Surg. San Francisco, CA 94108. 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. All rights reserved. As an example, the typical timeline for our Group B and C patients is as follows: 1. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. 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 . 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. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. Out-of-pocket costs for FFS. I don't philosophically agree with this. 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. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Now you will be denied! In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. 2018; 80:198204. This is the point at which you will likely need legal support. 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. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 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. 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. 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. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Please refer to theCare Credit websitefor further details. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. After a person pays the deductible, Medicare pays 80% of the allowable costs . If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Tseng P, Kaplan RS, Richman BD, et al. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 12. 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. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. The report of the 2015 U.S. transgender survey. 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