ffs surgeons who take insuranceffs surgeons who take insurance

insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. For example, there are now many hospitals across the . Data is temporarily unavailable. Submission and review of initial authorization request (1 month); 2. Price (USD) Forehead Recontouring. 11. Submission and review of second level, patient-initiated appeal (1 month); 4. However, this has been a persuasive strategy in some cases. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. There are a few limitations in this study that deserve mention. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 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. 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. 816-305-0943 Insurance Note:Utilizing insurance for Facial Feminization and Breast Augmentation procedures - Our office is experiencing reimbursement issues (claims NOT being paid by insurance companies) when filing facial feminization procedures and breast augmentation to insurance. They accept most major insurances and work to help you get your surgery fully covered whenever possible. 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. The doctor said very encouraging. 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. Dr. KathleynBrandstetter. The generalizability of the findings presented here is limited by state laws. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Wolters Kluwer Health How soon can I book a surgery date? may email you for journal alerts and information, but is committed 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. Costs of health care administration in the United States and Canada. Patients seeking services from our practice are personally and fully responsible for payment of all fees and costs related to your FFS surgery and medical care. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. Especially with the establishment of multi-disciplinary gender health teams across the United States, coordination of care through a consistent group of trained administrative staff knowledgeable in the process and appeals process for gender health procedures would potentially reduce the burden on individual offices and surgeons. 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. All rights reserved. 2. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. 2018; 80:198204. Due to the gender non-discrimination laws of the state, the denial is typically overturned and the procedures are authorized. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. 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. We can't guarantee insurance coverage but we can guarantee to try our hardest! In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Highly Distinguished Facial Surgeon In Chicago Dr. Amir Dorafshar, MD is a plastic and reconstructive surgeon with fellowship training in craniofacial surgery who specializes in gender-affirming facial surgery. An estimated 90% of all patient consults were approved for FFS under insurance. They submit their own information, information about the procedure being performed, and information about you. Finding a Surgeon Integral to this whole process is the FGCS surgeon. Second, while complications are not high in FFS, they may occur. The blossoming of academic medical centers offering transgender surgical care also means that more well respected surgeons, with appropriate craniofacial and maxilliofacial reconstructive training, are able to do procedures through insurance. 2018; 319:691697. Support groups? In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. Group B, consisting only of private insurance plans, are processes that initially resulted in denial, thereby requiring multi-level appeals. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Dr. Thomas Satterwhite Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. Surgical Staff: 13 surgeons, each specialized in surgery ranging from plastic to maxillofacial surgery. The Plastic Surgery Clinic of Chicago personalizes each and every treatment we perform by completing a full facial evaluation and discussing all possible options with you. Dr. Alan Dulin is a board-certified surgeon with many years of experience performing Male-to-Female Surgery in the Dallas area. Patients were stratified into 3 groups by authorization process. It's hard for any person to find their voice to self-advocate when such deeply personal needs are up for debate and judgement as "cosmetic" among random insurance company reviewers. 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. 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, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. The work cannot be changed in any way or used commercially without permission from the journal. Plast Reconstr Surg. Gender-Affirming Surgery: Original Article. If there is a section on transgender care that explicitly denies coverage for the procedures in Facial Gender Confirming Surgery, as many do, you can still attempt to advocate for them to be deemed medically necessary. 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.) Price on request Facial Feminization Surgery (FFS) View details & Read reviews CALL NOW. To filter results, enter information and 'click search icon' and/or select from the dropdown lists. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. In the Group A patients, FFS under Medi-Cal still requires preauthorization, just like private insurances. 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. N Engl J Med. Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps. Historically, FFS hasn't been covered by health insurance or government healthcare. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender affirming surgeries. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. 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. 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. 2018; 153:609616. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? 1. Read more about our Clinics Finance and Insurance Policy here. Dr. Mangubat is a board-certified cosmetic surgeon in the Seattle area who has been performing transgender surgery procedures for over twenty years. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. The time from initial consultation to final insurance denial required 5.1 0.7 months, nearly 5-fold higher than Group A (P = 0.003) (Fig. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Call 913-588-6200 to request a consultation. Start with ensuring that you have an in-depth understanding of your insurance benefits. Canner JK, Harfouch O, Kodadek LM, et al. Plast Reconstr Surg. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. Other costs to consider are: Our practice does NOT contract with any insurance providers to allay the cost of your facial feminization surgery. Available at: 2. Every insurance company is "difficult" to work with. Integral to this whole process is the FGCS surgeon. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. Societal implications of health insurance coverage for medically necessary services in the U.S. Transgender population: a cost-effectiveness analysis. Call Your Insurance Company to Ask if Gender Affirming Surgery is a Covered Benefit. Administering cosmetic fillers may take an hour or less, while complex facial surgery may take several hours. 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. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Days, whose birth name was Douglas, came out as transgender in January, 2015. Please read a few important elements consider when booking. Do you have a deductible to meet? Administrative time, including obtaining initial authorizations, appeals, IMRs, and additional phone calls, averaged to 7.2 1.0 hours spent per patient. *. Some of our patients use Care Credit to cover some of the cost of their facial feminization surgery. Dr. Mangubats excellent surgical skills, experience and dedication to transgender health have made him the most sought after surgeon for transgender surgery in the Pacific Northwest. 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. This is the point at which you will likely need legal support. 4. 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. Next, you want an awareness of any explicit inclusions or exclusions for transgender care in your "Certificate of Coverage," the document that lays out what is covered in what circumstances. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at OHSU. You need to come in for an in-person consultation AND pay a deposit to secure your surgery datebeforewe will submit for prior authorization. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Wolters Kluwer Health, Inc. All rights reserved. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 14. 2003; 349:768775. Otherwise, your deposit will be applied towards your surgical balance. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. However, California state law stipulates gender non-discrimination in health insurance, thus, Medi-Cal covers all procedures performed specifically for the purposes of gender affirmation. 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 2019; 144:11591168. Doximity. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. 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. Requiring letters from therapists and physicians appeals to some hospitals, surgeons, and care providers, who may look at this system as legally defensible if necessary. 3). Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. It involves plastic surgery techniques in which the jaw, chin, cheeks, forehead, nose, and areas surrounding the eyes, ears or lips are changed to create a more feminine appearance. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . 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. 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. 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. 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. Leigh JP, Tancredi D, Jerant A, et al. a support group of people dealing with similar issues to you to help keep up your strength and spirits throughout planning and recovery. Choose from multiple implant types and sizes. https://links.lww.com/PRSGO/B648.). Finally, Group C (denial) included private insurance plans under ERISA that resulted in denial despite multi-level appeals and IMR requested from the plan. Private insurances included health maintenance organizations and preferred provider organization. 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. However, its important to be aware that the terms and conditions of many insurance policies do not recognize coverage for the cost of FFS, or may exclude coverage for the services provided to you. Policy Issued By: Anthem. Dr. Leys multiple plastic surgery sub-specialty fellowships and gentle manner allow her to provide superb surgical care for transgender and non-binary patients. 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. Transgender women may choose FFS as part of their male-to-female transition process. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. 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. Upon receipt of a deposit for your surgery, our practice may offer to submit a prior authorization request to your insurance provider. 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. 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. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. $8995. 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. Though WPATH has released the new SOC, it will take insurance companies time to evolve. 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. . Get a bossy friend to make phone calls with you while you are dealing with 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. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). In addition, many of them don't take insurance. Your scars may take up to a year to heal. 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. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 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 . This means that the surgeon is either already in network with your insurance and is willing to send a prior authorization, or has an office willing to do the legwork of doing a letter of agreement with your insurance. 6. Do you have out of network benefits, or are you limited to providers in the network? surgical techniques and analysis of results. And some health insurance plans do cover the costs associated with facial feminization surgery procedures, so we recommend contacting your insurance provider to find out what is and is not covered under your current plan. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. Plast Reconstr Surg. 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). Facial Feminization Surgery: A Guide for the Transgendered Woman. If your insurance provider approves the authorization request, we may be able to submit a one-time complimentary claim on your behalf. 2010; 170:17281734. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Post Surgery Recovery. Upon denial, an IMR is requested directly from the insurance plan. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from . Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 1. Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Such multi-level appeals begin with a surgeon-initiated appeal, which is then also denied. 3). Qual Life Res. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. 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. https://links.lww.com/PRSGO/B648.). Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. Facial feminization surgery (FFS) for our male-to-female (M2F) patients can sometimes be the most important decision in your transition. 3. 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. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. However, this is starting to change. 6. Simplifying facial feminization surgery using virtual modeling on the female skull. Prior to meeting with the social worker, patients should complete this assessment document. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. 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. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Ainsworth TA, Spiegel JH. Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . According to the World Professional Association for Transgender Health, facial feminization surgery is particularly inaccessible because almost all insurance companies deem it a cosmetic procedure . Submission and review of IMR (1 month). Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters.

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