ffs surgeons who take insurance

We're gonna try really hard to get my insurance to cover it, but I'm not holding my breath. 2). 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. In addition to performing hundreds of gender-affirming procedures each year, Dr. Rumer also directs a 1-year gender surgery fellowship program. In total, 4 patients (10.0%) were ultimately denied despite multi-level appeals and IMR requests. For both Groups B and C, the authorization process averaged approximately 6 months, a 6-fold increase compared with Group A. 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. Woolhandler S, Campbell T, Himmelstein DU. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. insurance appeals for pediatric reconstructive surgery: a micro cost analysis and how-to guide. Facial feminization is the term given to a collection of procedures designed to make facial features more feminine. Secondly, the current study does not take into account the postsurgical administrative and billing time consumption and costs. Average months spent from initial facial feminization consultation to final insurance authorization decision. Finding a Surgeon Integral to this whole process is the FGCS surgeon. In September 2022, WPATH released the Standards of Care (SOC) version 8, for trans and gender-diverse medical and mental healthcare. (See table 1, Supplemental Digital Content 1, which displays requested CPT codes and associated terminology for facial feminization surgery. FFS can include hairline lowering, jaw reduction, rhinoplasty (nose reshaping), eyelid surgery, face or neck lift, and other facial changes. The cheapest caesarean section is 48,000 baht (year 2020) including sterilization 53,000 baht. 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. https://links.lww.com/PRSGO/B648.). 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. 3). The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. These delicate procedures change the male facial patterns to a softer, feminine appearance. Unlike California plans, self-insured plans are not under the CA DMHC and, thus, the final outcome is more variable. Jaw contouring contours the mandible and narrows a full jaw by reducing angles in the lower face. Submission and review of second level, patient-initiated appeal (1 month); 4. The generalizability of the findings presented here is limited by state laws. Bariatric Surgery. Facial feminization surgery, or FFS, describes a set of complex procedures designed to "feminize" the face. Facial feminization surgery (FFS) includes a series of plastic and craniofacial surgical procedures designed to feminize the face. 5. Plast Reconstr Surg. Dr. Thomas Satterwhite 1) and surveying administrative personnel and physicians to determine the approximate time spent on each step. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. There are a few limitations in this study that deserve mention. 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. Doximity. Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. 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. 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. Disclosure: All the authors have no financial interest to declare in relation to the content of this article. Average time spent from administrator and surgeon in obtaining insurance approval for FFS (A). Facial feminization surgery: the forehead. Some error has occurred while processing your request. 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. 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. The work cannot be changed in any way or used commercially without permission from the journal. James S, Herman J, Rankin S, et al. 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. 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. generic exclusions referenced under "general surgery guidelines" and "cosmetic procedures." South Dakota (0) State Medicaid has no . Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. Only if your insurance provider authorizes a Letter of Agreement. Most trans women elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). Group B (extended approval) primarily encompassed all patients who were initially denied but, after undergoing a multi-level appeal process, was ultimately approved. The multi-level appeal process included physician-initiated appeal, patient-initiated appeal, and independent medical review (IMR). We will commonly prescribe you with medications for common post-surgical side effects such as pain, nausea, and constipation. 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. 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. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. Ask to speak to people's supervisors. 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. 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. When it comes to facial feminization there is no substitute for experience. J Gen Intern Med. Costs of health care administration in the United States and Canada. He has been performing gender surgery since 2005. Are there transgender advocacy groups? Support groups? Plastic surgeons at Michigan Medicine are proud to provide Facial Feminization Surgery. Total Staff: 34. Both of these methods are. 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. Temporal trends in gender-affirming surgery among transgender patients in the United States. Rhinoplasty. Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. See all insurance information. The benefits of such coverage far exceed the insignificant costs. I am working from the perspective that you are unable to pay in full and be reimbursed. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Which, though I knew FFS is expensive, is a bigger estimate than I've ever seen for the procedure. 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. However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. This is their communication with the insurance company verifying that the procedure is covered. Prior to meeting with the social worker, patients should complete this assessment document. Leigh JP, Tancredi D, Jerant A, et al. How soon can I book a surgery date? Values: "At Kamol Hospital we provide a complete spectrum of fine cosmetic surgical procedures, performed by elite plastic surgeons setting new technological achievements. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. $4985. Otherwise, your deposit will be applied towards your surgical balance. Your insurance might have a requirement about length of time in care with them, or degree level. Every state is different so start with Google and reach out to these services in your state, theyre here for you! Privacy Policy (Updated December 15, 2022). The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. Subsequently, in California-insured plans, an IMR is then requested from the California Department of Managed Healthcare (CA DMHC). For patients anticipating insurance coverage for your surgery, we appreciate that you may wish to seek insurance reimbursement for the cost of some or all of your feminization procedures and have outlined some general guidelines below. This could be a good time to join (or form!) Complete New Patient Questionnaire. Descriptive statistics were performed for demographic variables. If they are a member of WPATH or other applicable professional associations, they should name that. information about insurance coverage: video.transcendlegal.org 2. 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. Staying in the hospital: Your procedure may be performed in a hospital or outpatient center. 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. These letters, in addition to following the WPATH standards of care, are the place to communicate the severity of the dysphoria- does your dysphoria impede activities of daily living, for instance by making you unable to leave for work on time? 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. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . Schedule surgery Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Dr. Freet accepts both insurance and Medicare. Get a bossy friend to make phone calls with you while you are dealing with the process. He is also skilled at multiple techniques of Top Surgery, Breast Augmentation and Body Sculpting. Furthermore, revisions may be indicated in some patients over time. Facial feminization surgery (FFS): The permanent . 2010; 170:17281734. Before getting into the nitty gritty details, let me be real with you, and let me be hopeful. Procedures requested for facial feminization insurance authorization are detailed in Table 2. (link is external) for CGSP. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. 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). You will be asked to complete an intake questionnaire before your consultation. Read more about our Clinics Finance and Insurance Policy here. We are looking forward to meeting you in person, hearing your aspirations, and tailoring a Surgical plan especially for you. They submit their own information, information about the procedure being performed, and information about you. Surgeries are performed by our world experts in facial reconstructive surgery, including: Drs. 2018; 80:198204. 14. 2003; 349:768775. It's an attempt to make the face as attractive as possible for as long as it lasts. 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. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Physician wages across specialties: informing the physician reimbursement debate. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. 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 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. 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. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. 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. Gray R, Nguyen K, Lee JC, et al. JCL is additionally supported by the US Department of Veterans Affairs under award number IK2 BX002442 and the National Institutes of Health/NIDCR R01 DE0289098. Publications See a list of publications about facial feminization by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine. 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. With a forehead reduction, our aim is to reduce a prominent brow or forehead bossing. In these circumstances, both complications and revisions are covered as reconstructive procedures, whereas self-pay patients may be responsible for secondary surgical costs. 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 . 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. 2016. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery. Dr. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery. 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. 1. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. Wolters Kluwer Health, Inc. All rights reserved. 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. Months required for definitive insurance authorization decisions for FFS. 8. 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. Facial feminization surgery (FFS) is a group of cosmetic procedures that reconstruct facial features that appear masculine and alter them to become more feminine. San Francisco, CA 94108. Days, whose birth name was Douglas, came out as transgender in January, 2015. This is the point at which you will likely need legal support. 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. Dr. Salgado is a board-certified plastic surgeon with deep expertise in gender-affirming procedures. Patients were stratified into 3 groups by authorization process. 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. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). If performed all at once, FFS usually takes between 4- 8 hours. Administrative time in this cohort included obtaining initial authorizations, which resulted in an average of 1.4 0.4 hours spent per patient at an estimated cost of $38.18 10.18 per patient (Fig. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. 2018 Physician Compensation Report. For example, a number of state-mandated denial overturns in Group B patients resulted in billing challenges postsurgery. Call 913-588-6200 to request a consultation. 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. To access this service, refer to the process below: Fill out and return the Service Inquiry Form. Submission and review of initial authorization request (1 month); 2. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. 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 surgery (FFS) uses a series of procedures to alter features to appear more classically female. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. The analysis was done by identifying individual steps involved in the insurance process (Fig. The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. Health Insurance Utilizing coverage under a health insurance plan is often the most affordable way to pay for FFS. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. Facial feminization surgery (FFS) encompasses a series of surgical interventions designed to make your face appear more feminine. ENQUIRE NOW. Please read a few important elements consider when booking. In addition, many of them don't take insurance. 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. A second subgroup of patients (Group B), all of whom had private insurance, were approved for surgery but required multi-level appeals, peer-to-peer discussions, and, ultimately, an IMR. Dr. Charles Shih. Dr. Ley has joined Dr. Scott Mossers Gender Confirmation Center in San Francisco, where she will begin seeing patients in March 2022. 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. Finally, you should have an idea of your local resources. 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. 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. 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. 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 . Policy Issued By: Anthem. The FFS Surgeons listed below are highly qualified plastic, cosmetic and maxillofacial Surgeons who regularly perform FFS. 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. 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%). No. Although your FFS may not be covered by your insurance company its definitely worth doing the research. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Facial feminization surgery: the forehead. 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. Dr. Thomas Satterwhite However, this is starting to change. This may influence the decision-making of surgeons with respect to the complexity of procedures to perform. Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. FFS consults (n = 40) at the University of California, Los Angeles (20182020) were reviewed for time and cost to definitive insurance authorization decision. We can't guarantee insurance coverage but we can guarantee to try our hardest! 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. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. Please note that before you can schedule . 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. P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery.

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