ffs surgeons who take insurance

Procedure. 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. Research that Matters. 2019; 144:11591168. 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. 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. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. All data were analyzed using SPSS software, version 25 (IBM, Chicago, Ill.). 1. Despite the time, effort, and costs incurred, 90.0% of patients were approved for FFS under insurance. Please read a few important elements consider when booking. Days, whose birth name was Douglas, came out as transgender in January, 2015. On average, the authorization process required approximately 1 month to complete and cost on average $38 worth of time to coordinate administratively. He serves as Division Chief of Plastic & Reconstructive Surgery at Rush University Medical Center in Chicago, and Program Director of the Plastic & Reconstructive Surgery Fellowship. Do you have out of network benefits, or are you limited to providers in the network? Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. Gender-Affirming Surgery: Original Article. Hoang H, Bertrand AA, Hu AC, et al. In this work, we report the methods, time consumption, costs, challenges, and successes of our institutional experience on obtaining insurance coverage for FFS. In the rare instance that FFS Surgery is included in your health insurance policy, services may be incomplete or function only on a reimbursement basis. Dr. Satterwhite is a board-certified Plastic and Craniofacial Surgeon in San Francisco who is dedicated to offering the highest level of surgical care to the transgender community. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. Dr. KathleynBrandstetter. Wolters Kluwer Health William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. 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. There are 301 level topics not covered here- going out of network to an office who will only give you CPT codes performed, getting a network exception to go to a provider with skills not available among in-network surgeons, etc. Though WPATH has released the new SOC, it will take insurance companies time to evolve. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. Once CGSP receives your form, you will be referred to Plastic Surgery for a consultation. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. Once you've identified a surgeon who takes your insurance, ask them to submit a preauthorization. Ultimately this letter is between you and your provider, but here is some sample language that has been helpful to patients I've worked with: "Patient X has been adherent to two years of hormone replacement therapy including (specific estrogen regimen.) 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. Dr. Mangubat specializes in Top Surgery, Breast Augmentation and Body Sculpting, Gender Confirming Facial Surgery and Hair Grafting. Some people stress additional mental health conditions (anxiety, depression, ptsd) in these letters. 50% of transgender women either had or wanted facial feminization (surgery to make a face appear more feminine). We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 2010; 170:17281734. FGCS is a collection of procedures designed to change the bone structure of the face and reshape features that resulted from testosterone exposure. 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. Demographic, clinical, and administrative data were retrospectively collected (UCLA IRB #19-001482). 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. 3. Dr. Thomas Satterwhite Included in Appendix D are the new letter referral suggestions for gender-affirming surgery (GAS). Tijuana, Cancun, Mexicali, and Monterrey are some of the more popular cities in Mexico for medical tourism and the flowing procedures: Dental treatments including dental surgery. Care Credit approval amounts can vary from person to person. How soon can I book a surgery date? 2018; 153:609616. Additionally, the timeline for authorization is relatively opaque, thereby causing more uncertainty in patients and surgeons. All rights reserved. Facial feminization surgery (FFS): The permanent . Lastly, the time consumption, costs, and difficulties to the patient were not assessed. Dr. Mundinger is a board-certified plastic surgeon with extensive training and expertise in craniofacial surgery, microsurgery and gender-affirming surgery. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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. 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). 2). 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]. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 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. 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. We identified 3 subsets of authorization processes, which partially correlated to the types of insurance plans of the respective patients. Facial feminization surgery: the forehead. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. ENQUIRE NOW. Do you have a deductible to meet? 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. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. Read this first. 1. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Every insurance company is "difficult" to work with. Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. TransHealthCare.org uses cookies and other tracking technologies to improve your browsing experience on our website, to analyze our website traffic, and to understand where our visitors are coming from. 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. Plastic and Cosmetic Surgery. These surgeries can reduce the size and shape of the forehead, alter and refine the nose, make the lips fuller and . Initially, you would need to be seen in the office for an examination/consultation to determine the scope of yoursurgeryto determine the exact cost of your facial feminization. Requested CPT codes are detailed in Supplemental Digital Content 1. 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. Leigh JP, Tancredi D, Jerant A, et al. Your insurance might have a requirement about length of time in care with them, or degree level. Woolhandler S, Campbell T, Himmelstein DU. During Your FFS Procedure How long it takes: This depends on what you are having done. Upon denial, an IMR is requested directly from the insurance plan. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. There is also a great deal of discussion on various internet forums and also on social media in terms of how to reduce the cost of your facial feminization surgery by claiming the procedure on your health insurance. Doximity. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . https://links.lww.com/PRSGO/B648.). 2014; 134:609619. 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.) Some of the procedures included in facial feminization surgery are: Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. The objective is to soften the facial . 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. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. Furthermore, revisions may be indicated in some patients over time. Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. 2015; 136:560e561e. In this work, we detailed our institutional experience on obtaining insurance coverage for FFS. Policy Title: Gender Affirming Surgery. Top facial feminization surgeons will typically undertake 2-3 facial full feminization procedures a week, this equates to at least 100 or more a year. These investigators reported patient satisfaction following facial feminization surgery, including outcome measurements after forehead slippage and chin re-modeling. 2018; 80:198204. 10. As an example, the typical timeline for our Group B and C patients is as follows: 1. Each letter should state "this procedure is medically necessary treatment. With all letters, I advise providers to be as authoritative in their tone as possible, and to explicitly claim an expert status if appropriate. 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 Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. 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. You will be asked to complete an intake questionnaire before your consultation. 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. You should be able to download this document through a web portal, but if not, you are legally entitled to a paper copy. 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. Only if your insurance provider authorizes a Letter of Agreement. Any reimbursement from the insurance company (if any) would be paid directly to the patient. JAMA Surg. Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. 2. Everyone who is able to fight through it cracks the door open a little wider for the next person. Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com. We detail our institutional experience to provide a roadmap for craniofacial surgeons to navigate the process in an effort to provide higher accessibility to transgender patients seeking facial reconstruction. 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. 5. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. your express consent. Now you will be denied! Plastic and Reconstructive Surgery Global Open9(5):e3572, May 2021. These procedures may include: Tummy tuck, called abdominoplasty. Average months spent from initial facial feminization consultation to final insurance authorization decision. Only patients with insurance authorization decisions were included in this study (n = 40). One of the greatest joys in my trans community work is helping people navigate Facial Gender Confirming Surgery. FHS/FFS (Facial Harmonization Surgery / Facial Feminization Surgery) Metoidioplasty/Phalloplasty Vaginoplasty/Vulvoplasty Classes cover the following material: Surgical options and techniques Surgery planning and pathway at Kaiser Post-operative care and recovery Most sessions also include a patient panel 3). Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Dr. Andrew Kleinberger. I cannot tell you what insurance plan to get that covers FGCS, there are too many variables. Choose from multiple implant types and sizes. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. The benefits of such coverage far exceed the insignificant costs. However, the cost can range from $1,847 to $62,000, depending on a few key factors. Please note that before you can schedule . He offers Facial Feminization and Masculinization Surgery as part of the Gender Affirmation Surgery Program at Rush university Medical Center. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Among the total cohort, most patients had private insurance (n = 23, 57.5%), followed by Medi-Cal (n = 13, 32.5%), and Medicare (n = 4, 10.0%). The addition of multi-level appeals in Groups B and C increased the total time for a definitive decision (7.0 and 5.1 months, respectively) and required both surgeon and administrative time to navigate the process (10.8 and 12.0 hours, respectively). This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. Known for her surgical skill and artistry, Dr. Nghiems patients also love her kind and caring demeanor. 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. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. If you work for an employer who supports your gender confirmation surgery your first point of contact should be your in-house health insurance liaison. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). Plast Reconstr Surg. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. Dr. Dulin offers transgender women the following surgical services: Breast Augmentation: Get the curves you desire. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. I could go on about this, but I hate to further the expectation that you must be very mentally ill in order for the "extreme" treatment of FGCS to be warranted. 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. No. Please try after some time. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Specific surgical procedures were requested based on patient desires and clinical assessment, with the goal of completing FFS in a one-stage surgery. 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. Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. surgical techniques and analysis of results. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Two letters from mental health providers. 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. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. The report of the 2015 U.S. transgender survey. Call 913-588-6200 to request a consultation. Surgery Scheduling, Rescheduling and Cancellations: Oakland Head and Neck . Error bars denote standard error. $8995. Some error has occurred while processing your request. Complete New Patient Questionnaire. A total of 36 patients (90.0%) have been approved by insurance. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. This guide is 201 level, geared towards those who find themselves covered with an ACA exchange plan or private insurance, as Medicaid processes are much more state specific. Submission and review of initial authorization request (1 month); 2. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. Integral to this whole process is the FGCS surgeon. Procedures requested for facial feminization insurance authorization are detailed in Table 2. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. 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.

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