ffs surgeons who take insurance

A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. JAMA Surg. Price (USD) Forehead Recontouring. Some of the procedures included in facial feminization surgery are: Facial Feminization Surgery: A Guide for the Transgendered Woman. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. surgical techniques and analysis of results. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. Furthermore, revisions may be indicated in some patients over time. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Conveniently Located to Serve Chicago and Illinois. Look here for licensed dentists practicing in the state. You will be asked to complete an intake questionnaire before your consultation. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Plast Reconstr Surg. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . your express consent. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. 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. 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. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Health insurance is unnecessarily difficult when it comes to gender affirming surgery. 3). However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. ENQUIRE NOW. 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. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Days, whose birth name was Douglas, came out as transgender in January, 2015. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Plast Reconstr Surg. Dr. Dorafshar is a highly distinguished plastic and reconstructive surgeon who specializes in gender-affirming facial surgery. Rhinoplasty. He has been performing gender surgery since 2005. Are there transgender advocacy groups? In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. The report of the 2015 U.S. transgender survey. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Notes. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. 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. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. 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. 2020; 8:e2618. Simplifying facial feminization surgery using virtual modeling on the female skull. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Dr. All rights reserved. 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. 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. 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. 2018 Physician Compensation Report. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. The objective is to soften the facial . In total, the time and cost estimate of the insurance appeal process was 10.8 1.0 hours and $855.00 91.53 per patient, respectively. Requires supporting documentation that indicates specific type of FFS procedures requested. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Dr. Dulin is a board-certified surgeon with many years of experience performing Top Surgery, Metoidioplasty, Breast Augmentation, FFS and Orchiectomy. 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. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. Finally, you should have an idea of your local resources. Complete New Patient Questionnaire. Available at: 9. Estimated costs of obtaining insurance approval for FFS (B). Please first read this resource for a general overview of insurance utilization for trans surgery. Received for publication February 2, 2021; accepted February 27, 2021. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Male-to-female (MTF) facial feminization. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. 3). Please try after some time. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Dr. Javad Sajan, MD is a Cosmetic, Plastic and Reconstructive Surgeon in Seattle who specializes in Gender-Affirming Surgery including Top Surgery, Breast Augmentation, Body Sculpting and Facial Feminization. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Read more. Dr. KathleynBrandstetter. 2018; 319:691697. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. There are a few limitations in this study that deserve mention. Read on to find out why you might pay more or less, and whether the cost is really worth it. Some error has occurred while processing your request. Patients were stratified into 3 groups by authorization process. Please keep track of the mail being sent to the address on file with insurance, as you often are only able to appeal within certain time frames from the initial decision. Please try again soon. Thus, coverage significantly increases accessibility. Get a bossy friend to make phone calls with you while you are dealing with the process. Ask them how many FFS surgeries they perform within a year. 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). This could be a good time to join (or form!) Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. 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. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. Both of these methods are. 1. 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. From the cohort, 3 subgroups were delineated. 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.) Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. Post Surgery Recovery. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . Additionally, planning and recovering from any trans surgery is hard! 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. LGBT legal service projects? Bariatric Surgery. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. 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). Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 2015; 136:560e561e. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. In addition to following WPATHs SOC format, it is helpful if it is specifically tailored to FGCS. Thus, specifying any one procedure as medically necessary while excluding other facial procedures reflects a lack of understanding of the nature of the diagnosis. Plast Reconstr Surg. All patients with public insurance (Medi-Cal or Medicare) as well as a small subset of private insurance plans were approved after initial submission of authorization request or did not require approval before surgery (Medicare) (Fig. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Error bars denote standard error. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Lastly, the time consumption, costs, and difficulties to the patient were not assessed. As an example, the typical timeline for our Group B and C patients is as follows: 1. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. Body-contouring. $8995. Private insurances included health maintenance organizations and preferred provider organization. $4985. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Plastic and Cosmetic Surgery. Procedures requested for facial feminization insurance authorization are detailed in Table 2. 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. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. These procedures may include: Tummy tuck, called abdominoplasty. Second, while complications are not high in FFS, they may occur. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. JCL is additionally supported by the US Department of Veterans Affairs under award number IK2 BX002442 and the National Institutes of Health/NIDCR R01 DE0289098. With a view to clarifying this issue and answering frequently asked questions, we have compiled the following information in an effort to not only outline how Deschamps-Braly Clinic handles finance and insurance coverage but to also provide general information about how to approach your own health insurance company regarding the cost of your facial feminization. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 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. Facial feminization surgery can be covered by health insurance in some instances. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. 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.) 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. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). 1). 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. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Now you will be denied! https://links.lww.com/PRSGO/B648.) Costs of health care administration in the United States and Canada. 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. As with any surgical procedure, there are risks associated with FFS. They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Gender-Affirming Surgery: Original Article. Dr. Charles Shih. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Bottom surgery, or changing the genitalia, costs an estimated $25,600 for male-to-female patients and about $24,900 for female-to-male, according to The Philadelphia Center for Transgender. An estimated 10 patients (25.0%), all with private insurance, underwent an extended approval process requiring multi-level appeals and denial overturn after IMR and frequently, state intervention. A total of 36 patients (90.0%) have been approved by insurance. 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. 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. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. 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.

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