Insurance Coverage For Facial Feminization Surgery (FFS)
Facial Feminization and Insurance - Your Questions Answered
We are often asked by our patients if their health insurance will cover their facial feminization surgery. There is 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.
For many trans people, insurance is a minefield of confusion
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 for facial feminization surgery but to also provide general information about how to approach your own health insurance company.
NOTE: The following is intended as a high-level overview and guide only and does not in any way constitute legal or professional advice. Please contact your health insurance company or patient advocate for more specific information.
Frequently Asked Questions (FAQ) about Insurance Coverage and the Cost of Facial Feminization Surgery
1. How much does facial feminization surgery cost?
Initially, you would need to be seen in the office for an examination/consultation to determine the scope of your FFS to determine the exact cost of your surgery. Other costs to consider are:
- Anesthesia and operating room fees (both of which are charged by the duration of time used)
- Overnight stay at the hospital
- Hardware (any implants or inserts)
- Any additional planning/coordination to complete the surgery (VSP, Orthodontic treatment, etc.)
- You will also need to factor in the costs of airfare, transportation, and accommodation if you’re not from the San Francisco Bay Area
2. Does the Deschamps-Braly Clinic contract with any insurance providers?
Our practice does NOT contract with any insurance providers. Facial feminization 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.
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. However, it’s important to be aware that the terms and conditions of many insurance policies do not recognize coverage for FFS, or may exclude coverage for the services provided to you. If your insurance provider approves the authorization request, we may be able to submit a one time complementary claim on your behalf. We are not responsible for any insurance documentation, reimbursement, denials, or appeals.
3. Should I contact my insurance provider directly to verify what out of network coverage, if any, is available for FFS?
Upon receipt of a deposit for your surgery, our practice may offer to submit a “prior authorization” request to your insurance provider. A “prior authorization” is not a guarantee of payment, therefore, you should have funds available to cover all fees and costs related to your surgery should your request be denied. Patients who receive a prior authorization are still required to pay for their facial feminization surgery costs in advance. Any reimbursement from the insurance company (if any) would be paid directly to the patient.
4. How do I find out if my insurance provider covers FFS?
Although your FFS may not be covered by your insurance company it’s definitely worth doing the research. Start with ensuring that you have an in-depth understanding of your insurance benefits. Read your cover in detail and find out the following:
- Do you have a deductible to meet?
- What’s your out-of-pocket maximum cost?
- Do you have access to out-of-network providers or in-network only?
Second, find out if your Certificate of Coverage has any inclusions (or exclusions) around transgender care. You should be able to have easy access to this document through your insurance provider.
5. My insurance says they cover FFS, so I’m okay right?
You need to be aware that there may be a difference between the “allowed amount” (maximum paid by the insurance company) and the “billed amount” (the amount that the clinic charges for the surgery).
6. Can I finance my facial feminization surgery through financing or payment plans?
Some of our patients use Care Credit to cover some of the costs for their facial feminization surgery. Care Credit approval amounts can vary from person to person. Please refer to the Care Credit website for further details.
7. Can I obtain a prior authorization for my health insurance before I come in for a consultation?
No. You need to come in for an in-person consultation AND pay a deposit to secure your surgery date before we will submit for a prior authorization.
8. Is my deposit refundable if my insurance authorizes my procedure?
Only if your insurance provider authorizes a Letter of Agreement. Otherwise, your deposit will be applied towards your surgical balance.
9. Where can I get additional help and support for FFS?
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. If not, remember you’re never alone and there are a range of transgender support agencies that you can tap into. Try your local trans advocacy groups, LGBTI legal services, support group, etc. Every state is different so start with Google and reach out to these services in your state, they’re here for you!