Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 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. 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. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. The pre-surgical authorization process for patients in Groups B and C, constituting 60.8% of all private insurance patients in our cohort, is highly time-consuming due to the individual review periods required for each level. Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. Surgery will be carried out under general anaesthetic and can typically range from around 4 to 8 hours depending on the procedures. Descriptive statistics were performed for demographic variables. *. Los Angeles, CA: University of California, Los Angeles School of Law; 2019. may email you for journal alerts and information, but is committed Bariatric Surgery. In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. Temporal trends in gender-affirming surgery among transgender patients in the United States. This is their communication with the insurance company verifying that the procedure is covered. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Two letters from mental health providers. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Data is temporarily unavailable. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. 14. Any reimbursement from the insurance company (if any) would be paid directly to the patient. 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 called facial feminization surgery. 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. This should be sent to you in written form, with the specific reason for the denial included. 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. 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. 3. 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. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 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. Doximity. A total of 36 patients (90.0%) have been approved by insurance. Upon denial, an IMR is requested directly from the insurance plan. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. surgical techniques and analysis of results. Facial feminization surgery: the forehead. Though WPATH has released the new SOC, it will take insurance companies time to evolve. 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. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. In addition, many of them don't take insurance. 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. 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. Ann Plast Surg. 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. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Complete New Patient Questionnaire. Facial Feminization Surgery: A Guide for the Transgendered Woman. https://links.lww.com/PRSGO/B647.). 2020; 8:e2618. KP FFS Surgeons. 1. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. 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. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. Qual Life Res. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . 12. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Now you will be denied! For more information, please refer to our Privacy Policy. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. 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. He has been performing gender surgery since 2005. The total time from initial consultation to authorization approval in Group B required 7.0 1.1 months, a 6-fold longer process compared with Group A patients (P < 0.001) (Fig. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. Want to use our data? Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Other medical procedures like dermatology, orthopedics, gynecology, and ophthalmology. 13. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Dr. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Most other insurance plans do not cover FFS and consider it as cosmetic surgery. In contrast to Group A, patients who required significant efforts in the form of multi-level appeals, peer-to-peer reviews, and IMRs were designated Groups B and C, depending on ultimate approval versus denial as the outcomes, respectively. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. 15. Raffaini M, Magri AS, Agostini T. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. 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). NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. Dr. Thomas Satterwhite LGBT legal service projects? I am working from the perspective that you are unable to pay in full and be reimbursed. 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. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Tate, who has been with Starbucks for 15 years and now manages a store in Austin, Texas, is one of a growing number of Starbucks partners who have used the company's leading-edge benefits for transgender partners. 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. 2016; 137:438448. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. 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. Procedures requested for facial feminization insurance authorization are detailed in Table 2. 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. 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. Available at: 9. 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. Read more about our Clinics Finance and Insurance Policy here. Unlike Group B, patients within Group C only had plans that were self-insured under ERISA. Available at: 2. 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. I don't philosophically agree with this. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. Some error has occurred while processing your request. 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. Please enable scripts and reload this page. 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. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 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. 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. 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. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. If they have referenced expert guidelines or current research in devising your care plan, they should state that and provide citations. Care Credit approval amounts can vary from person to person. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. 10. 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. Gray R, Nguyen K, Lee JC, et al. 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. Ousterhout DK. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Wolters Kluwer Health Hormone therapy alone has not sufficiently treated her gender dysphoria, and the next step in her treatment plan is Facial Gender Confirming Surgery." Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. If performed all at once, FFS usually takes between 4- 8 hours. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Your insurance might have a requirement about length of time in care with them, or degree level. The work cannot be changed in any way or used commercially without permission from the journal. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. 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. Do you have out of network benefits, or are you limited to providers in the network? $4985. 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. 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. to maintaining your privacy and will not share your personal information without 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. 2). information about insurance coverage: video.transcendlegal.org 2. Simplifying facial feminization surgery using virtual modeling on the female skull. 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. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. FFS may include a brow lift, cheek augmentation, rhinoplasty, and lip augmentation. https://links.lww.com/PRSGO/B648.) Both of these methods are. FFS is ideal for trans women and non-transgender women who want a more feminine facial appearance. This is also the point at which general 201 level guidance ceases to be useful. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 3). We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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*,. When it comes to facial feminization there is no substitute for experience. Dr. Lee has gained worldwide recognition as an FFS specialist after it was announced that he performed Caitlyn Jenners facial . 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 A letter from your primary care provider or whoever prescribes your hormones. What's your out of pocket max? 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). 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. Costs of health care administration in the United States and Canada. Submission and review of second level, patient-initiated appeal (1 month); 4.
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