Hello everyone!

I'm insured by Kaiser through my mother (she works there and gets a very good plan), and since I heard that Kaiser recently adopted new policies about transgender health services, I decided to look into our plan and see what's covered, how much is covered, etc.

I reviewed the overall changes to the policy, which basically said that top and bottom surgery are covered for FTM patients, up to $75,000 lifetime. On my specific plan, it says it covers "Transgender Services" and "Transgender Day Surgery" at the price of our plan's standard copay.

I'm really excited to hear that I'm covered somehow, but the Kaiser website lacks any information on how this works, or even an email address to a department that could give me that information. After searching around there for several days, I'm a little bit frustrated.

So, does anyone have any information about it? Anyone gotten hormones or top/bottom surgery through Kaiser? Specifically, information about which surgeons Kaiser can send me to/which surgeons accept Kaiser would be greatly appreciated.

I know you posted this a few months ago, but have you made any progress?  I too have Kaiser insurance and I saw that it includes "Transgender Services." I'm ready to take action as soon as I figure out their system.  As far as I can tell, I need to make an appointment with my primary doctor so that they can refer me to a therapist or specialist. 

You should be able to contact them via phone or email to find out specifics about your plan. There should be a contact form available.
I contacted mine (I'm BCBS though, so I can't give specifics for your situation), and the referred me to a pdf about what they covered.
Good luck. Keep us posted in case anyone else has these kinds of questions.

Quote from: zero.cool.crash.override on July 22, 2014, 11:09:11 PM
I know you posted this a few months ago, but have you made any progress?  I too have Kaiser insurance and I saw that it includes "Transgender Services." I'm ready to take action as soon as I figure out their system.  As far as I can tell, I need to make an appointment with my primary doctor so that they can refer me to a therapist or specialist.

I have! This is the way Kaiser works as far as I understand:

They cover hormones and top and bottom surgery for trans patients if it's included as part of your plan (on their website, there should be something like "Transgender Day Surgery" and "Transgender Services" on your page). In California and one other state (I think it's Nevada, but don't quote me on that), it should be covered under all plans.

First thing I would do is call your local hospital and asked to be assigned to a trans-knowledgeable doctor. Once that had been done for me, my new doc was able to walk me through all the steps required to start T, but I'll summarize them here as well. I had an appointment with my new doctor, and she referred me to the psychiatrist. It was about an hour long appointment with the psych, and they just basically went over my life and why I want to transition and all that to make sure I was aware of what I was doing. After that, my doc referred me to the endocrinologist and I started T. It sounds a lot simpler than it was; count on a lot of confusion and phone calls and appointments.

As far as surgery goes, I believe they want you to have been on T for a year beforehand, and they'll do a panel review to determine your eligibility for surgery (your psych should be able to vouch for you and easily get you past this step.)

I hope that helps, but please let me know if you need any more information. And good luck!

Here's some helpful information for anyone looking to get bottom surgery through Kaiser.  If you are in Southern California, the bottom surgeons they go through are Dr. Crane in Northern California and Dr. Meltzer in Arizona.  I'm currently in process to get phalloplasty with Crane, hopefully next June or July.  At the point of starting this process, I was two years on testosterone and 1.5 years post top surgery.

First, I sent an email to the transgender nurse coordinator (pm me if you want the any names or emails of the health care providers I mention), and she hooked me up with an appointment with a Kaiser therapist who specializes in transgender care (my main therapist is not in the Kaiser network).  He wrote the first surgery letter during the first appointment and referred me to another therapist in the same building for the second letter.

After both letters were written, the transgender nurse coordinator submitted my information for evaluation and approval.  After that went through, I was able to start surgery consults.  To get phallo with Dr. Crane, Kaiser has you get a hysterectomy with one of their doctors, but if you want a meta with Crane or either surgery with Meltzer, the hysto can be done at the same time as the bottom surgery.

I have my hysto scheduled for August 8th (very excited) and just had my consult with Dr. Crane a few days ago.  We are going to see about scheduling a surgery date once his office staff gets back in the office.

I am happy to answer any questions or clarify anything to the best of my ability for anyone else looking to get surgery through Kaiser.

Daniel006, you must be so happy to be getting lined up for your hysto and phalloplasty.  I would so much like to get a hysto and be rid of those extra parts that can always be trying to cause a problem.  I am still deciding what kind of lower surgery I want.

Dante, thank you so much for outlining your experience.  That is exactly the information I was seeking.  I really appreciate it.  Over the past few days, I've been making phone calls.  I called Kaiser Member Services, who transferred me to another department, who referred me to someone else, who gave me another number... Finally I got the right person/department, and he pretty much said, "All of our physicians are knowledgeable about transgender issues." Yeah, sure.  Anyhow, I'll try going through my existing randomly-selected primary physician and see if he'll refer me to a psychiatrist or therapist.  Or maybe he'll suggest a different primary physician.

Daniel006 my husband wants bottom surgery. Are you saying Kaiser will allow him to go to Dr. Crane for surgery?
He had his top surgery the Dr. Crane already.

Daniel006 - Do you have to pay upfront for the surgery?  I'm just really curious as I had surgery with doctor Crane last year and was looking to have a revision done and testicular implants.  They would have been covered by insurance.  I was told by Crane's office that I would need to pay the $9,000 upfront and then be reimbursed for the surgery.  Just wondering if you were told the same or not.  I didn't have to pay upfront for my first surgery, so I assumed it was an office change in procedures.

Quote from: Daniel006 on July 24, 2014, 12:46:43 PM
Here's some helpful information for anyone looking to get bottom surgery through Kaiser.  If you are in Southern California, the bottom surgeons they go through are Dr. Crane in Northern California and Dr. Meltzer in Arizona.  I'm currently in process to get phalloplasty with Crane, hopefully next June or July.  At the point of starting this process, I was two years on testosterone and 1.5 years post top surgery.

First, I sent an email to the transgender nurse coordinator (pm me if you want the any names or emails of the health care providers I mention), and she hooked me up with an appointment with a Kaiser therapist who specializes in transgender care (my main therapist is not in the Kaiser network).  He wrote the first surgery letter during the first appointment and referred me to another therapist in the same building for the second letter.

After both letters were written, the transgender nurse coordinator submitted my information for evaluation and approval.  After that went through, I was able to start surgery consults.  To get phallo with Dr. Crane, Kaiser has you get a hysterectomy with one of their doctors, but if you want a meta with Crane or either surgery with Meltzer, the hysto can be done at the same time as the bottom surgery.

I have my hysto scheduled for August 8th (very excited) and just had my consult with Dr. Crane a few days ago.  We are going to see about scheduling a surgery date once his office staff gets back in the office.

I am happy to answer any questions or clarify anything to the best of my ability for anyone else looking to get surgery through Kaiser.

I am have kaiser and I would like to know if you could help me. I am not sure who to contact but I am seeing someone outside of kaiser to start T . But I feel like kaiser has no idea what to do with me. First they sent me to a psychiatrist and she tells me I'm not knowledgeable on that but I know someone else outside of kaiser. So I go and pay out of pocket. Would you help me and guide me on how to have kaiser send me to the right people.

Sorry I missed this thread earlier.  Other people have posted helpful and accurate info.  I am currently serving as the volunteer patient representative to the national Kaiser Transgender Champions Team. 

Quote from: Logan24 on June 29, 2015, 09:37:14 AM
I am have kaiser and I would like to know if you could help me. I am not sure who to contact but I am seeing someone outside of kaiser to start T . But I feel like kaiser has no idea what to do with me. First they sent me to a psychiatrist and she tells me I'm not knowledgeable on that but I know someone else outside of kaiser. So I go and pay out of pocket. Would you help me and guide me on how to have kaiser send me to the right people.

There are literally hundreds of different "plans" KP tailors for employer groups and individuals so it is important to know exactly what we are covered for.  Membership services is one good place to start and they should be aware of who is LGBTQ friendly and who is specializing in our care.  Then a lot depends on what Kaiser region we are in.  California has had comprehensive services and specialty centers for years.  This reflects another political reality.  The States and Wash DC, where our care has been mandated by law, are way ahead of the regions just getting more established like the KPNW region where I live.  It is critically important that again, we know what is in our plan.  I thought I had the cadillac coverage being a retired KP provider myself.  Then in the process of getting an orchiectomy I discovered this odious and discriminatory "rider" business.  Basically some regions still sell plans that do not provide for our comprehensive Trans care unless there is a specific rider purchased as part of the plan.  KP has begun to address this issue by gathering data directly from us with a "Lantern Project" that puts a spotlight on our concerns.  They are also looking at a KPNW regional advisory group specific to transgender care and increasing attention to cultural sensitivity and diversity awareness training.  New intake forms asking the appropriate name, gender and pronoun questions are being instituted. I am part of these effort and advocate for us at every meeting. 

Please PM me for more specific questions or anything I might be able to help with to improve our care at KP.

Dr tong at kaiser performed my top surgery. I would recommend her highly. I'm very pleased with the results and she was very kind, as well as her staff.

If you have kaiser and want surgery google kaiser transitions clinic, make an appointment, and do as they ask. I had to attend groups then got my recommendation. I feel the clinic saved my life, I'm very pleased with the services I received from kaiser, you can get T recs, surgery and some support and resources

Dr Tong was great, I had no drains, my nipples worked, etc. Shes very skilled surgeon.

I actually didn't go through my general physician. I called the appointment center to make the gender orientation appointment, but it took a few transfers. Although I have to find a new physician because my current one is moving. I will be going to my gender assessment next week and hope to get more info as to who the surgeons for top surgery are.   

Quote from: the emcee on June 06, 2017, 09:32:27 PM
Dr tong at kaiser performed my top surgery. I would recommend her highly. I'm very pleased with the results and she was very kind, as well as her staff.

If you have kaiser and want surgery google kaiser transitions clinic, make an appointment, and do as they ask. I had to attend groups then got my recommendation. I feel the clinic saved my life, I'm very pleased with the services I received from kaiser, you can get T recs, surgery and some support and resources

Dr Tong was great, I had no drains, my nipples worked, etc. Shes very skilled surgeon.

Sorry to interrupt. However, I have been catching up on newly posting members. That leads me to say hi and welcome to the site.

Thanks for sharing your experience. It is invaluable to our members. Maybe you could go to our Introductions category and post. That way we can get to know you better.

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If 2017 commenting is okay, I just want to say that for the past decade-ish, I've hardly met any ftms who had decent transition coverage outside of Kaiser.

Quote from: Felix on August 19, 2017, 09:35:53 PM
If 2017 commenting is okay, I just want to say that for the past decade-ish, I've hardly met any ftms who had decent transition coverage outside of Kaiser.

Aetna and Kaiser both function similarly and tend to be good. Everything else is going to vary by state. BCBS seems to be decent in most states.

I'm actually getting my top covered by Kaiser here in Colorado.

Since my last post in 2015 I have been working as a volunteer and patient representative with Kaiser Permanente relative to our care.   Kaiser has made a sincere commitment to parity and equity in their regional service areas and available plans.  We now have much broader and more universal coverage for transition and transgender related care.

The chaos and uncertainty of the current political administration and those seeking to eliminate the Affordable Health Care Act are a challenge to the health care and insurance industry.  Much of that industry is still moving forward with equitable and more comprehensive care.  It's the right thing to do.  Discrimination is clearly wrong.

I encourage us to be assertive consumers and know what coverage is in our health care plan before we buy.