Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience
Background:. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process....
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2021-05-01
|
| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003572 |
| _version_ | 1818362915602825216 |
|---|---|
| author | Allison C. Hu, BA Brian N. Dang, BS Anthony A. Bertrand, MD, MBA Nirbhay S. Jain, MD Candace H. Chan, BS Justine C. Lee, MD, PhD, FACS |
| author_facet | Allison C. Hu, BA Brian N. Dang, BS Anthony A. Bertrand, MD, MBA Nirbhay S. Jain, MD Candace H. Chan, BS Justine C. Lee, MD, PhD, FACS |
| author_sort | Allison C. Hu, BA |
| collection | DOAJ |
| description | Background:. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process.
Methods:. FFS consults (n = 40) at the University of California, Los Angeles (2018–2020) were reviewed for time and cost to definitive insurance authorization decision. 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.
Results:. An estimated 90% of all patient consults were approved for FFS under insurance. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 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). 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.
Conclusion:. 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. |
| first_indexed | 2024-12-13T21:40:10Z |
| format | Article |
| id | doaj.art-c6f88888ae3e49c6843e2dc840c1f9ce |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-13T21:40:10Z |
| publishDate | 2021-05-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-c6f88888ae3e49c6843e2dc840c1f9ce2022-12-21T23:30:35ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-05-0195e357210.1097/GOX.0000000000003572202105000-00023Facial Feminization Surgery under Insurance: The University of California Los Angeles ExperienceAllison C. Hu, BA0Brian N. Dang, BS1Anthony A. Bertrand, MD, MBA2Nirbhay S. Jain, MD3Candace H. Chan, BS4Justine C. Lee, MD, PhD, FACS5From the * Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.From the * Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.From the * Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.From the * Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.From the * Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.From the * Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.Background:. Despite improved insurance coverage for gender confirmation surgeries in the United States, coverage for facial feminization surgery (FFS) continues to be difficult. Here, we describe our institutional experience on navigation, time, and costs of the FFS insurance authorization process. Methods:. FFS consults (n = 40) at the University of California, Los Angeles (2018–2020) were reviewed for time and cost to definitive insurance authorization decision. 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. Results:. An estimated 90% of all patient consults were approved for FFS under insurance. Group A averaged 1.1 months for approval, requiring 1.4 hours of administrative time translating to $38.18 per patient. 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). 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. Conclusion:. 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.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003572 |
| spellingShingle | Allison C. Hu, BA Brian N. Dang, BS Anthony A. Bertrand, MD, MBA Nirbhay S. Jain, MD Candace H. Chan, BS Justine C. Lee, MD, PhD, FACS Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience Plastic and Reconstructive Surgery, Global Open |
| title | Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience |
| title_full | Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience |
| title_fullStr | Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience |
| title_full_unstemmed | Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience |
| title_short | Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience |
| title_sort | facial feminization surgery under insurance the university of california los angeles experience |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003572 |
| work_keys_str_mv | AT allisonchuba facialfeminizationsurgeryunderinsurancetheuniversityofcalifornialosangelesexperience AT brianndangbs facialfeminizationsurgeryunderinsurancetheuniversityofcalifornialosangelesexperience AT anthonyabertrandmdmba facialfeminizationsurgeryunderinsurancetheuniversityofcalifornialosangelesexperience AT nirbhaysjainmd facialfeminizationsurgeryunderinsurancetheuniversityofcalifornialosangelesexperience AT candacehchanbs facialfeminizationsurgeryunderinsurancetheuniversityofcalifornialosangelesexperience AT justinecleemdphdfacs facialfeminizationsurgeryunderinsurancetheuniversityofcalifornialosangelesexperience |