ffs surgeons who take insurance ffs surgeons who take insurance

Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a . 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. 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. Andrew Kleinberger. 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. 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. 2015; 136:560e561e. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage 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. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 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. However, some insurers are beginning to cover FFS from select surgeons. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Start with ensuring that you have an in-depth understanding of your insurance benefits. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. 2010; 170:17281734. Dr. As many professions say, past performance does not guarantee future results. However, the tide of change is beginning to roll in- often where Medicaid begins, private plans will be forced to follow, so the clear coverage in California and New York bodes well for everyone. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. 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. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Your scars may take up to a year to heal. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. 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. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. 2018; 319:691697. 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. 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Please try after some time. The generalizability of the findings presented here is limited by state laws. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. 2. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. A surgeon who takes your insurance, hopefully in-network or willing to do the legwork of a single case agreement, with whom you are ready to move forward in planning surgery. I always advise people to try with the insurance they have before they switch to another plan. If performed all at once, FFS usually takes between 4- 8 hours. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 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). Privacy Policy (Updated December 15, 2022). insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Available at: 2. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . They accept most major insurances and work to help you get your surgery fully covered whenever possible. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. In fact, he is one of the most experienced gender surgeons in the world. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. 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. While facial feminization surgery has many potential benefits, the decision to proceed . Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. 2019; 144:11591168. Wolters Kluwer Health Descriptive statistics were performed for demographic variables. Private insurances included health maintenance organizations and preferred provider organization. Procedure. Our team will help you set up a MyChart account where you will have the ability to fill this out online. A letter from your primary care provider or whoever prescribes your hormones. 4. 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. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. 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. 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. Your message has been successfully sent to your colleague. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. 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. Until then, CCTS will continue to require all patients using insurance for . 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. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 1. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Additionally, planning and recovering from any trans surgery is hard! Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. 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. 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. This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. He has been performing gender surgery since 2005. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). 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. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Prior to meeting with the social worker, patients should complete this assessment document. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Read this first. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. As with any surgical procedure, there are risks associated with FFS. 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. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. 14. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Post-surgery garments; Medical tests and x-rays; When choosing a board-certified plastic surgeon for facial feminization surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery. Plast Reconstr Surg. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Policy Issued By: Anthem. Compared with Group A, the amount of time spent acquiring the authorization was 8-fold higher (P < 0.001), with a 22-fold higher cost (P < 0.001) for the Group B authorization process (Fig. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Out-of-pocket costs for FFS. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. Body-contouring. The addition of multi-level appeals in Groups B and C increased the total time for a definitive decision (7.0 and 5.1 months, respectively) and required both surgeon and administrative time to navigate the process (10.8 and 12.0 hours, respectively). Patients seeking services from our practice are personally and fully responsible for payment of all fees and costs related to your FFS surgery and medical care. Facial feminization surgery can be covered by health insurance in some instances. The report of the 2015 U.S. transgender survey. may email you for journal alerts and information, but is committed Thus, coverage significantly increases accessibility. Requires supporting documentation that indicates specific type of FFS procedures requested. $8995. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Ask to speak to people's supervisors. The United States . 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%). FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. This is also the point at which general 201 level guidance ceases to be useful. All rights reserved. Dr. KathleynBrandstetter. Only patients with insurance authorization decisions were included in this study (n = 40). This guide is 201 level, geared towards those who find themselves covered with an ACA exchange plan or private insurance, as Medicaid processes are much more state specific. 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. Padula WV, Heru S, Campbell JD. 10. Notes. Ainsworth TA, Spiegel JH. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. Received for publication February 2, 2021; accepted February 27, 2021. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Facial Feminization Surgery: A Guide for the Transgendered Woman. The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. They submit their own information, information about the procedure being performed, and information about you. We can't guarantee insurance coverage but we can guarantee to try our hardest! 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. 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. Braun TL, Braun JL, Hernandez C, et al. 2016; 31:394401. 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. Please enable scripts and reload this page. Want to use our data? These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Plast Reconstr Surg. It's an attempt to make the face as attractive as possible for as long as it lasts. Every insurance company is "difficult" to work with. 3. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 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. As gender dysphoria is highly individual, such procedures will vary by anatomical areas associated with dysphoria for each individual patient as well as decision-making from the treating surgeon. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. However, this has been a persuasive strategy in some cases. to maintaining your privacy and will not share your personal information without Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Transgender women may choose FFS as part of their male-to-female transition process. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. This process will be long and draining, but it is worth it. 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). Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Plastic surgery on the face. This could be a good time to join (or form!) 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. Months required for definitive insurance authorization decisions for FFS. Read more. 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. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. 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. Now you will be denied! 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. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. No. 2). The structure of this system sucks, but it's the one in which you find yourself and it is your responsibility to make it work for you. 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. . Submission and review of initial authorization request (1 month); 2.