If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Prior to meeting with the social worker, patients should complete this assessment document. 3). https://links.lww.com/PRSGO/B648.). After a person pays the deductible, Medicare pays 80% of the allowable costs . Available at: 9. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 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. Woolhandler S, Campbell T, Himmelstein DU. 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. Descriptive statistics were performed for demographic variables. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Rhinoplasty. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Plast Reconstr Surg Glob Open. Upon denial, an IMR is requested directly from the insurance plan. Canner JK, Harfouch O, Kodadek LM, et al. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. He has been performing gender surgery since 2005. Requires supporting documentation that indicates specific type of FFS procedures requested. Otherwise, your deposit will be applied towards your surgical balance. Despite these reports, coverage continues to be variable from state to state, physician to physician, as well as depending on anatomical region. 11. 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. 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. 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. LGBT legal service projects? If they are a member of WPATH or other applicable professional associations, they should name that. The concept and treatments were developed with transfeminine patients in mind in the 1980s, led by a San Francisco-based surgeon who devised measurements for a "normal" female appearance by surveying anthropological skeletal records. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 12. Doctors and nurses take good care. Braun TL, Braun JL, Hernandez C, et al. You may be trying to access this site from a secured browser on the server. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Two letters from mental health providers. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. However, this is starting to change. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 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. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 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. 3). Facial feminization surgery (FFS): The permanent . Only patients with insurance authorization decisions were included in this study (n = 40). Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Submission and review of physician-initiated appeal (1 month); 3. According to the Philadelphia Center for Transgender Surgery,. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. Error bars denote standard error. Ousterhout DK. A total of 36 patients (90.0%) have been approved by insurance. 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. San Francisco, CA 94108. 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. 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. 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. 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.) Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. 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. What's your out of pocket max? to maintaining your privacy and will not share your personal information without Each patient is different and your expectations and desired results will be discussed fully in your consultation. JAMA Surg. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. These delicate procedures change the male facial patterns to a softer, feminine appearance. Please read a few important elements consider when booking. Dr. Thomas Satterwhite Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Are there transgender advocacy groups? In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 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). Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. 6. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. 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. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. 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. 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. 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). Requested CPT codes are detailed in Supplemental Digital Content 1. 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.
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