Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. $8995. He has been performing gender surgery since 2005. Rhinoplasty. Descriptive statistics were performed for demographic variables. 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). 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. 6. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. 2. 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. The United States . This should be sent to you in written form, with the specific reason for the denial included. Additionally, planning and recovering from any trans surgery is hard! 15. From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. Now you will be denied! 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. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 360 Post St. Suite 901 Post-surgery garments; Medical tests and x-rays; When choosing a board-certified plastic surgeon for facial feminization surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery. The benefits of such coverage far exceed the insignificant costs. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . 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. Furthermore, even in the challenging scenario for insurance authorization reported by Braun and colleagues, Groups B and C also exceed reported estimates. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. ENQUIRE NOW. Plast Reconstr Surg. 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. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. In fact, he is one of the most experienced gender surgeons in the world. 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. Some of the procedures included in facial feminization surgery are: The analysis was done by identifying individual steps involved in the insurance process (Fig. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. Facial feminization surgery can be covered by health insurance in some instances. 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. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? 2018; 153:609616. Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Co-insurance past that? may email you for journal alerts and information, but is committed Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). 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. 3. 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 . This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. 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. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. 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. FFS is a cost-effective intervention that needs to be covered by insurance policies. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Historically, FFS hasn't been covered by health insurance or government healthcare. 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. Because Medicare patients (n = 4) do not need prior authorization, they were excluded from the time and cost analysis of the insurance appeal process for Group A. San Francisco, CA 94108. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. I am working from the perspective that you are unable to pay in full and be reimbursed. Canner JK, Harfouch O, Kodadek LM, et al. 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. This process will be long and draining, but it is worth it. Bariatric Surgery. 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. JAMA Surg. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Copyright TransHealthCare.org & Trans Media Network, 2011-2022. Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. 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. Plast Reconstr Surg. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 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. 2020 Deschamps-braly clinic. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. 2. This procedure can alter both soft tissues as well as the facial bone to achieve more feminine-looking facial features. You may be trying to access this site from a secured browser on the server. Research that Matters. 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. 3). We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. 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. Policy Title: Gender Affirming Surgery. Post Surgery Recovery. 2016. Plastic and Cosmetic Surgery. However, some insurers are beginning to cover FFS from select surgeons. Read more on our Insurance and Finance page. Arch Intern Med. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 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. Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. I always advise people to try with the insurance they have before they switch to another plan. Physician wages across specialties: informing the physician reimbursement debate. Woolhandler S, Campbell T, Himmelstein DU. KP FFS Surgeons. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. 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. Tseng P, Kaplan RS, Richman BD, et al. Gender-Affirming Surgery: Original Article. If the insurer refuses those attempts, you can appeal externally, but that will almost certainly require professional legal support. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. Please enable scripts and reload this page. 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.
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