ffs surgeons who take insurance

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. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. These are usually self-insured employer plans which are administered by well-known insurers such as Blue Cross Blue Shield, United Healthcare, Harvard Pilgrim Healthcare, and Tufts Health Plan. 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 information about insurance coverage: video.transcendlegal.org 2. to maintaining your privacy and will not share your personal information without *, Time and cost of the insurance approval process for FFS. Thirdly, it is likely that the current work underestimated the total cost of the insurance approval process, as we could not quantify the cost of surgery cancelations, additional clinic visits, and unquantifiable administrative time. Privacy Policy (Updated December 15, 2022). Although your FFS may not be covered by your insurance company its definitely worth doing the research. Braun TL, Braun JL, Hernandez C, et al. The format for an appeals process and regulations/law/policy to cite within it vary widely depending on the mix of state and local regulations that apply to your specific plan. 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. 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. Though WPATH has released the new SOC, it will take insurance companies time to evolve. 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. Policy Issued By: Anthem. Additionally, planning and recovering from any trans surgery is hard! Facial Feminization Surgery (FFS) Preparation Guide. Finally, you should have an idea of your local resources. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. 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. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. ENQUIRE NOW. Error bars denote standard error. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Your insurance might have a requirement about length of time in care with them, or degree level. 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. 7. 3). 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. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Hu, Allison C. BA*; Dang, Brian N. BS*; Bertrand, Anthony A. MD, MBA*; Jain, Nirbhay S. MD*; Chan, Candace H. BS*; Lee, Justine C. MD, PhD, FACS*,. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Call 913-588-6200 to request a consultation. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. This should be sent to you in written form, with the specific reason for the denial included. 2015; 136:560e561e. Please note that before you can schedule . For more information, please refer to our Privacy Policy. 2018 Physician Compensation Report. Get a bossy friend to make phone calls with you while you are dealing with the process. Submission and review of IMR (1 month). 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%). Some of the procedures included in facial feminization surgery are: Read more. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 10. 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. Costs of health care administration in the United States and Canada. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. 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. Conveniently Located to Serve Chicago and Illinois. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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). 15. 11. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Americans who are considering surgery as part of their transition can find the cost of gender-affirming surgery to be steep. 2018; 319:691697. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. 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. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. Brow Lift. Submission and review of physician-initiated appeal (1 month); 3. Temporal trends in gender-affirming surgery among transgender patients in the United States. 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. The report of the 2015 U.S. transgender survey. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Available at: 9. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Everyone who is able to fight through it cracks the door open a little wider for the next person. Based on my conversations with friends who are very satisfied with their FGCS, I assure you that no surgery can completely resolve that anxiety. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. No. 2010; 19:10191024. Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. 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. This could be a good time to join (or form!) His experience in cosmetic and craniofacial surgery makes him an excellent choice for Facial Feminization (FFS) and Masculinization surgeries. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. Doximity. Historically, FFS hasn't been covered by health insurance or government healthcare. 2016; 31:394401. 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. This is their communication with the insurance company verifying that the procedure is covered. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL) and the Jean Perkins Foundation (JCL). Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. In contrast, FFS under insurance coverage allows for inpatient care, which may be important, particularly to surgeon decision-making as well as patients who may have other medical conditions, pain control issues, or those who travel from long distances. Read on to find out why you might pay more or less, and whether the cost is really worth it. Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). $8995. Physician wages across specialties: informing the physician reimbursement debate. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. In fact, he is one of the most experienced gender surgeons in the world. 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. Hoang H, Bertrand AA, Hu AC, et al. The United States . Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. 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). Plastic and Cosmetic Surgery. I don't philosophically agree with this. JAMA. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. 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. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Estimated costs of obtaining insurance approval for FFS (B). Analyses of variance with posthoc comparisons under the Tukey criterion were used to compare time from consultation to approval or denial, time spent obtaining insurance authorization, and cost. . Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. Support groups? Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. 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. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. When it comes to facial feminization there is no substitute for experience. 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. Plast Reconstr Surg. A letter from your primary care provider or whoever prescribes your hormones. 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. J Gen Intern Med. Submission and review of initial authorization request (1 month); 2. First, one of the most significant barriers to FFS for patients is the ability to pay for surgery, which ranges from $40,000 upwards for full-face, one-stage 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. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. How soon can I book a surgery date? You need to be aware that there may be a difference between theallowed amount(maximum paid by the insurance company) and thebilled amount(the amount that the clinic charges for the surgery). Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Please refer to theCare Credit websitefor further details. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 2. 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. I am working from the perspective that you are unable to pay in full and be reimbursed. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. As with any surgical procedure, there are risks associated with FFS. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. 2018. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Price (USD) Forehead Recontouring. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. 3). 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 2). William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. An estimated 90% of all patient consults were approved for FFS under insurance. 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. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. This is the point at which you will likely need legal support. 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. One potential consideration for reducing time and costs is to centralize administrative staff for gender health insurance authorizations. Only if your insurance provider authorizes a Letter of Agreement. 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. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Facial Feminization Surgery A Complete Guide to FFS, Fat Transfer for Facial Feminization (FFS), Cheek Enhancement (Augmentation & Reduction), Ethno-Specific Facial Feminization Surgery, Forehead Reshaping (Contouring & Reduction), Chin Contouring (Genioplasty/Mentoplasty), Read more about our Clinics Finance and Insurance Policy here, Cheek Enhancement: Augmentation and Reduction, Adams Apple Surgery Augmentation via Natural Implant, Anesthesia and operating room fees (both of which are charged by the duration of time used), Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Facial Feminization Surgery (FFS) is becoming more and more popular, but it can be hard to narrow down the surgeons who best perform these complex surgeries. Only patients with insurance authorization decisions were included in this study (n = 40). The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Co-insurance past that? If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. Top facial feminization surgeons will typically undertake 2-3 facial full feminization procedures a week, this equates to at least 100 or more a year. 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. There are a few limitations in this study that deserve mention. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. During Your FFS Procedure How long it takes: This depends on what you are having done. Days, whose birth name was Douglas, came out as transgender in January, 2015. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. Transgender women may choose FFS as part of their male-to-female transition process. The administrator hourly compensation set at our institution was used for the cost analysis. 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. 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. You may be trying to access this site from a secured browser on the server. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. Group A is similar to other medically necessary reconstructive procedures where authorization is requested and procedures are authorized. 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 If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. The major difference between approval (Group B) versus denial (Group C) was that the former primarily consisted of plans insured by California and, thus, under the jurisdiction of California law, whereas Group C plans were entirely self-insured employer (ERISA) plans, which are exempt from state regulation. KP FFS Surgeons. Facial feminization surgery can be covered by health insurance in some instances. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? These procedures may include: Tummy tuck, called abdominoplasty. 3. While facial feminization surgery has many potential benefits, the decision to proceed . If not, remember youre never alone and there are a range of transgender support agencies that you can tap into.

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