Submission and review of second level, patient-initiated appeal (1 month); 4. However, I personally know multiple people who have achieved coverage for FGCS through state Medicaid in both NY and California. Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. Total Staff: 34. However, some insurers are beginning to cover FFS from select surgeons. 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). These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. 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. When it comes to facial feminization there is no substitute for experience. 3. Braun TL, Braun JL, Hernandez C, et al. Subsequently, the process typically follows one of three paths: Group A (standard approval), Group B (extended approval), and Group C (denial). (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. They submit their own information, information about the procedure being performed, and information about you. The average cost of facial feminization surgery (FFS) is $34,504, according to 213 reviews from RealSelf members. 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. Her surgery was performed by a craniofacial surgical team called the FACIALTEAM. Location: Bangkok, Thailand. 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. Ultimately, you will need to contact your health insurance company or patient advocate for more specific information regarding costs. 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. Months required for definitive insurance authorization decisions for FFS. Fortunately, as insurance coverage for gender confirmation surgeries has increased, so has physician interest in training. William Hoffman, MD and Jason Pomerantz, MD from the UCSF Division of Plastic Surgery, and Drs. Some will result in eventual approval (Group B) and others will result in eventual denial (Group C). However, we are not responsible for any insurance documentation, reimbursement, denials, or appeals. Plast Reconstr Surg. Patients were stratified into 3 groups by authorization process. Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. In addition to legislative changes, the rationale for increasing coverage may be related to calculations on the cost-effectiveness of coverage. Please refer to theCare Credit websitefor further details. 2010; 170:17281734. Furthermore, revisions may be indicated in some patients over time. Do you have access to out-of-network providers or in-network only. 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.
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