Copyright TransHealthCare.org & Trans Media Network, 2011-2022. $4985. Now you will be denied! For more information, please refer to our Privacy Policy. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. All rights reserved. Dr. Youssef is a top Cosmetic Surgeon in the greater Los Angeles area and Director of the Transgender Surgery Institute of Southern California. 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. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. This is called facial feminization surgery. 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. 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. 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 Facial feminization surgery: the forehead. I am working from the perspective that you are unable to pay in full and be reimbursed. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Price (USD) Forehead Recontouring. 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). Submission and review of physician-initiated appeal (1 month); 3. Data is temporarily unavailable. Available at: 2. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. 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. This denial should also lay out your options for appeal- both internal (basically, asking the insurance company to reconsider) and external. Otherwise, your deposit will be applied towards your surgical balance. 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. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. Furthermore, revisions may be indicated in some patients over time. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . 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. Administrative costs have been estimated to account for 31% of health care expenditures in the United States.13 At the level of individual academic surgical practices, contemporary estimations of processing time and total costs for billing and insurance-related activities were 100 minutes and $215.10 for an inpatient surgical procedure in 2017.14 Time and costs for activities carried out by physicians were estimated at a median of 15 minutes or $51.20 for an inpatient surgical procedure.14 In plastic surgery, Braun and colleagues have performed a similar study evaluating the time and cost burden of insurance denials for pediatric patients with congenital breast anomalies.15 Their work estimated that the average pre-surgery insurance process to cost $445.36 and require 7.4 hours of institutional time. Descriptive statistics were performed for demographic variables. Location: Bangkok, Thailand. He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. Justine C. Lee, MD, PhD, FACS, University of California, Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960, E-mail: [emailprotected]. Please enable scripts and reload this page. The analysis was done by identifying individual steps involved in the insurance process (Fig. 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. 1. Though specifics required by insurance vary (and might be laid out explicitly in your Certificate of Coverage) I recommend every person have three letters of support. After a person pays the deductible, Medicare pays 80% of the allowable costs . Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Additionally, planning and recovering from any trans surgery is hard! KP FFS Surgeons. 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. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Dr. Thomas Satterwhite 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. 1). Upon denial, an IMR is requested directly from the insurance plan. 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 We can't guarantee insurance coverage but we can guarantee to try our hardest! You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. The differences between male and female facial features vary with age, ethnicity, and how early hormonal therapy began. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). Your message has been successfully sent to your colleague. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. Brow Lift. $8995. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. 2018; 153:609616. Some error has occurred while processing your request. Integral to this whole process is the FGCS surgeon. 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. One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. Temporal trends in gender-affirming surgery among transgender patients in the United States. . Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. Error bars denote standard error. 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. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. 3. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. 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). 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. They submit their own information, information about the procedure being performed, and information about you. Facial Feminization Surgery provides dramatic changes to the male face which helps facilitate Male to Female (MTF) Transgender patients to fully live in the female role and be perceived as a woman with confidence. 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. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Dr. Charles Shih. Second, while complications are not high in FFS, they may occur. Requires supporting documentation that indicates specific type of FFS procedures requested. 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. Hoang H, Bertrand AA, Hu AC, et al. The generalizability of the findings presented here is limited by state laws. 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. Costs of health care administration in the United States and Canada. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Both of these methods are. Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist). 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. Our team will help you set up a MyChart account where you will have the ability to fill this out online. Leigh JP, Tancredi D, Jerant A, et al. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. 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). Facial Feminization Surgery (FFS) Preparation Guide. 2018; 80:198204. 2010; 19:10191024. No. Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. Received for publication February 2, 2021; accepted February 27, 2021. Lastly, a third subgroup of patients (Group C), all with private insurance, were denied for surgery despite multi-level appeals, peer-to-peer discussions, and IMR. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Want to use our data? In fact, he is one of the most experienced gender surgeons in the world. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. For example, some may be reluctant to perform an osteotomy of the anterior table of the frontal bone for setback in an outpatient surgery center and, thus, default to a less aggressive method of frontal bone recontouring, which may be an undercorrection for certain patients. This should be sent to you in written form, with the specific reason for the denial included. 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.
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