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. Though WPATH has released the new SOC, it will take insurance companies time to evolve. *, Time and cost of the insurance approval process for FFS. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. 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.) 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. 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. 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. 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. 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, . 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. In addition to administrative time, multi-level appeals required time from the attending craniofacial surgeon for peer-to-peer reviews, writing appeal letters, and patient counseling over the 6-month period, in total averaging 3.6 0.5 hours per patient. Do you have a deductible to meet? The benefits of such coverage far exceed the insignificant costs. Months required for definitive insurance authorization decisions for FFS. 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. 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. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. 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. 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.) Facial Feminization Surgery - Costs - What does FFS cost? - 2pass Clinic Dr. Rumer is a board-certified plastic and reconstructive surgeon in the Philadelphia tri-state area who has deep experience with gender reassignment surgery and a practice that is geared exclusively toward transgender patients. You should be able to have easy access to this document through your insurance provider. Costs of health care administration in the United States and Canada. Error bars denote standard error. 2016. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. Privacy Policy (Updated December 15, 2022). Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? Starbucks offers expanded benefits for trans people Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 12. 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 However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Facial Feminization Surgery Timeline - Gender Confirmation Please try again soon. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 2. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Using Insurance for Facial Gender Confirming Surgery or "FFS" Requires supporting documentation that indicates specific type of FFS procedures requested. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . 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. Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. 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. 2). Complete New Patient Questionnaire. Facial feminization surgery: the forehead. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. No. Plastic and Cosmetic Surgery. Tseng P, Kaplan RS, Richman BD, et al. However, some insurers are beginning to cover FFS from select surgeons. Braun TL, Braun JL, Hernandez C, et al. PDF Facial Feminization Surgery (FFS) Preparation Guide - Thrive 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. Insurance and facial feminization surgery - 2pass Clinic 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. Notes. Facial Feminization Surgery: Everything You Need to Know - Verywell Health Ask them how many FFS surgeries they perform within a year. Plastic surgery on the face. 3). 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. Canner JK, Harfouch O, Kodadek LM, et al. Gray R, Nguyen K, Lee JC, et al. Does Medicare cover gender reassignment surgery? - Medical News Today Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . Male-to-female (MTF) facial feminization. Facial Feminization Surgery (FFS) Miami, FL - Dr. Salgado Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Facial Feminization Surgery NYC | Board Certified Plastic Surgeon If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Dr. KathleynBrandstetter. Private insurances included health maintenance organizations and preferred provider organization.