ffs surgeons who take insurance
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. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Do you have a deductible to meet? Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Try your local trans advocacy groups, LGBTI legal services, support group, etc. One patient may have severe dysphoria over their forehead, while one may have dysphoria over their upper lip. Facial feminization surgery (FFS) involves a comprehensive set of procedures to make your face appear more feminine. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Physician wages across specialties: informing the physician reimbursement debate. $4985. 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. As stated above, all patients within this group were covered by private insurance plans that were not within the purview of the State of California and, thus, were not eligible for state intervention. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. FGCS is a treatment for gender dysphoria related to the secondary sex characteristics in the face, not a treatment for anxiety caused by the experience of having gender dysphoria or being a transgender person in an unkind world. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. Gray R, Nguyen K, Lee JC, et al. The benefits of such coverage far exceed the insignificant costs. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Facial Feminization Surgery (FFS) is a group of facial procedures that alter the face to create more classically feminine characteristics, such as a higher brow, a more refined feminine nose, and less pronounced Adams apple. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 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). Doctors and surgeons trained in facial feminization surgery are working to improve care for people living with gender dysphoria. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. Resources in other locations are variable, but I'm attempting a general starter guide to FGCS through insurance. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. 6. Patients seeking services from our practice arepersonally and fully responsible for paymentof all fees and costs related to your FFS surgery and medical care. 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. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Every insurance company is "difficult" to work with. HB2084 (2016) bans gender identity discrimination in health insurance and HB2405 (2022) bans categorical exclusions for gender-affirming care under any health plan, though the law does not . An estimated 90% of all patient consults were approved for FFS under insurance. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. Thus, coverage significantly increases accessibility. Third, full-face, one-stage FFS is a highly time-consuming surgery due to the multiple anatomical areas addressed at once (averaging 8.5 hours in the senior authors experience). All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). We are often asked by our patients about the cost offacial feminizationand if their health insurance will cover them for thevariety of proceduresincluded in their surgery. Ann Plast Surg. It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. Have your facial features compromised your safety, making you a target for harassment and violence? Conveniently Located to Serve Chicago and Illinois. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? 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. This process will be long and draining, but it is worth it. Health insurance might not cover surgical procedures considered cosmetic for the cisgender population people whose gender identity matches the one they were assigned at birth even though these procedures are . 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. Regardless, I recommend that you fight everything out in the preauthorization/pre service review process, and not after you have already paid and might be left holding the bill. Plastic and Cosmetic Surgery. 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. Out-of-pocket costs for FFS. Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. We can't guarantee insurance coverage but we can guarantee to try our hardest! generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . They will need letters of support from you for the preauthorization, following WPATHs Standards Of Care. Qual Life Res. 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. 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. 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. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. $8995. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Braun TL, Braun JL, Hernandez C, et al. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 1). 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). Your health insurance company can't limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear. Historically, FFS hasn't been covered by health insurance or government healthcare. 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. Total Staff: 34. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. What's your out of pocket max? Facial feminization surgery: the forehead. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Hoang H, Bertrand AA, Hu AC, et al. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). 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. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. your express consent. This guide may also be useful for people planning other procedures considered cosmetic and/or explicitly listed as not covered under their transgender benefits (breast augmentation, body contouring, facial masculinization surgery, etc.). Otherwise, your deposit will be applied towards your surgical balance. 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. The surgeons listed below are highly qualified plastic, reconstructive, craniofacial, maxillofacial and cosmetic surgeons who offer gender-affirming facial surgery. 2016; 137:438448. A Systematic Review of Tranexamic Acid in Plastic Surgery: Whats New? Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. I tell everyone to plan for an initial denial- even if FGCS is covered in your plan clearly, its likely that portions of the procedure will be denied as cosmetic. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. Health insurance is unnecessarily difficult when it comes to gender affirming surgery. Similarly, while Medicare does not require an authorization process to move forward with surgery, we have experienced significant billing challenges postsurgery. Compared with the published literature, patients within Groups B and C are multi-fold greater than the reported standard estimates in the former study without even taking into account time and costs of post-surgical billing activities. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. 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. 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. A total of 36 patients (90.0%) have been approved by insurance. See all insurance information. 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. 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. Surgical techniques and analysis of results. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process.