FFS Insurance

Dr. Rodman believes that all patients should have access to excellent healthcare.  She is one of the few offices that accepts insurance for FFS. Dr. Rodman will work with all insurance companies, but is an out of network provider.  Ms Laurie De Paz is the insurance concierge for Face Forward. She works to assist patients in getting coverage for FFS procedures. The process to get FFS covered is long and time consuming.  In order to continue to provide care to all patients, we ask for patients to take an active role in preparing for surgery. We also ask that patients understand that Dr. Rodman’s staff work very hard to move these cases through the process, and to respect and appreciate the work they put in to taking care of each patient.

Before your consult:

1. Call your insurance company to see if the procedures are covered.  View common Facial Feminization Insurance Codes.

The codes must be covered with dx of gender dysphoria F64.0

2. Send our office your insurance information, including a copy of your card
3. Send a copy of your insurance policy which states that these codes are covered with F64.0
4. Have 3 letters stating the medical necessity of FFS to treat gender dysphoria.  Per WPATH standards, these are usually from an endocrinologist or PCP who prescribes your hormones, a psychologist, and another clinician (ideally another mental health provider).
5. List of what facilities in Houston are approved by your insurance

After consult

  • Dr Rodman will determine which procedures will create the most feminine face for you
  • If you wish to proceed, the office requires a $1000 deposit to begin the pre-authorization process.  This will be applied to any fees owed for deductible and coinsurance at the time of surgery
  • If the surgery is denied, the money will be refunded less a $250 processing fee (patient will get back $750).
  • We will submit the codes for your procedures for your insurance
  • We will post your pre-authorization  # in your patient portal
  • You may call your insurance company as often as you’d like to check the status

Note this process may take weeks to months.  Dr Rodman’s office will follow up with the insurance company once per week

Once codes are approved, the insurance company will need to coordinate with our billing specialist and sign a letter of agreement.

Finding a Facility

Once the letter of agreement is settled we will look for a facility. We will try to find one in-network with your insurance.

Note there are not many facilities that have the equipment to do FFS properly.

If Dr. Rodman is not credentialed at a facility approved by your insurance, or said facility does not have the equipment, the patient will have to apply for GAP coverage to get surgery.  The surgery must be done in a facility that is safe, well equipped, and knows how to care for trans patients. All surgery centers are not equal, and Dr. Rodman will not compromise quality or patient safety.

Surgery

Patients who need more than 8 hours of surgery will be required to stay overnight.  This may not be covered under insurance. In some cases patients have paid up front and been reimbursed by insurance.  Staying overnight is for patient safety and cannot be compromised.

There are also some procedures that patients desire, (such as skin tightening with Renuvion) that are not covered under insurance.  Patients will be responsible for the cost of these.

  • Once the LOA and facility are approved, we can schedule surgery.
  • There may still be issues before the date.
  • Be prepared, this is not a short process.

If more than 10 hours of surgery is needed, the surgery may be split up into two days.  The surgeries can be done one week apart, and the patient will still stay two weeks in Houston.  Usually the forehead, nose, and lip lift will be done in the first surgery. The second surgery will be jaw, chin, Adam’s apple reduction, Renuvion skin tightening, face/neck lift, and fat grafting will be performed on the second day.

In total, patients should plan to stay for two weeks in Houston. 

Denial

In the event of denial, the patient may appeal.

In cases where the patient has secondary insurance that may cover the procedures, Dr Rodman’s office can assist with the appeal.

For patients who do not have a secondary plan and the procedures are not covered by policy, there is the option of paying out of pocket.  Dr. Rodman does have financing options including Care Credit and Alpheon.

https://goalphaeon.com/welcomeplasticsurgery

https://www.carecredit.com/howcarecreditworks/

Nationally, some patients have gotten legal help to appeal their claim.