Kaiser GRS surgeons. : Transgender

Kaiser GRS surgeons.

Mon Sep 21 16:50:05 2020 UTC

(16 comments)

Hello all, I am looking to have my GRS done late next year. I will be on kaiser and using their surgeons whick I thought would be DR Poh in LA. After talking to Kaiser I was informed that I would be getting my surgery done in Arizona. I assume that means that it would be the metzler clinic performed by metzler or or Ley.

Has anyone done their GRS through kaiser recently and which doctor did you have. Any recommendations on the choice of doctors of I have one?

On a side note, can you do GRS and breast augmentation at the same time?

all 16 comments

u/Glowie2012

Mon Sep 21 18:30:48 2020 UTC

(2 children)

I had mine done by Dr. Meltzer through Kaiser

u/LunaSeydoux

Mon Sep 21 20:10:54 2020 UTC

(1 child)

Did you like the work? I have read a lot of complaints about Metzler.

u/Glowie2012

Mon Sep 21 21:28:26 2020 UTC

(0 children)

I have been satisfied. Overall the experience went well. I know some other women that have not had such good results with Meltzer. I have issues with dilating but I’m not sure if that is because of him or me. I think at some point I may get a revision down. It looks good though and I can get off so overall it’s not bad.

u/[deleted]

Mon Sep 21 18:31:58 2020 UTC

(8 children)

I went to Dr. Salim/Dr. Thomas at KP NorCal. I'm pretty happy with the results although I'm considering a revision because I think he left a little too much erectile tissue. I had mine in early 2018 and I was one of his early patients. I'd rate the results as pretty good cosmetically, and very good functionally. He's had a lot more patients since me, so he may be even better now. Idk if I'd go with any of their other surgeons. But I'm speaking with a little bias because:

when I saw results by other KP surgeons they were all relatively new with the exception of Meltzer, obviously. (Although I think his 2-stage approach is ridiculously outdated now and his cosmetic results aren't great by modern standards) I don't know anything about Dr. Ley who is also at that clinic.
I've had a bad experience with Kaiser as a whole in terms of asking for revisions and trying to get care post-op. It's like I don't matter to them anymore and it's really frustrating. :-(

Also, I'm not sure if this is accurate but according to this person, KP NorCal stopped referring patients to Dr. Meltzer. If it's true, I'm wondering why KP SoCal continues to use him. https://www.tobymeltzer.com/fired-from-kaiser

u/LunaSeydoux

Mon Sep 21 22:40:13 2020 UTC

(1 child)

Thanks for the information, I just want to have the best results that I can have. I am not certain want what kind of choice I will have, or why they plan to send me to Arizona. My insurance will be Kaiser of Georgia, so that may have something to do with it.

u/[deleted]

Mon Sep 21 22:48:26 2020 UTC

(0 children)

Yeah. That's probably why. The multi-specialty trans clinic here stopped sending patients to him a couple of years ago. Although when I had my GCS he was still an option. Going to Arizona was enough to make me 'nope' out though. I was originally supposed to go to Dr. Satterwhite, but they ended the contract with him when they hired Dr. Salim at Kaiser San Francisco. I still wish I could have gone with him though. That was my first shitty Kaiser experience. I felt like I got a 'bait and switch.' I had even consulted with Dr. Satterwhite. Then one day they called and said he wasn't covered anymore... fuckers.

Like I said my results are fine. Everything works how it should. But I wish my vagina looked a little bit better. I don't have a bad result, and I was one of the earlier patients, so I'd still recommend looking into them. Dr. Salim is a really good person too. I'd at least ask, Kaiser is Kaiser right? If they'll send you to AZ, why not San Francisco?

Just to clarify my quibbles, imo I don't have enough of a labia minora. Everything looks very natural when I have my legs closed but if I open them I think it looks a bit too spread out. I may seek a PPT revision to get a little more depth and a minor cosmetic revision.

u/KP_TransitionJournal

Tue Sep 22 14:00:46 2020 UTC

(5 children)

I'm planning to have surgery in SoCal with Dr. poh. What kind of push back did they give you for revision?

Also what trouble did you have with post-op care?

I would file a grievance if you haven't already. It will open up a case and someone from grievance department will contact you and try to help find a solution. If they deny the revision you can file an appeal too.

u/[deleted]

Tue Sep 22 17:56:49 2020 UTC

(4 children)

I posted all about it when I wrote about my FFS. https://www.reddit.com/r/Transgender_Surgeries/comments/guotds/a_note_of_caution_about_kaiser_ffs_and_their/

Quick Summary: I'm VERY unsatisfied with my FFS results and the surgeons performed my Type-III osteotomy incorrectly. I was gaslighted for 2 years and then denied a revision by my doctor and needed to get an outside opinion and then go to Sacramento to get another evaluation. When that KP doc agreed that a revision was necessary, I filed a grievance to get a more experienced doctor in my area and was denied again. The IMR (the state appeals process in CA) upheld Kaiser's denial, even though the surgeon they referred me to is 100 miles away and has never done a revision before and had only done like 10 FFS surgeries before in total. To me, it seemed a lot easier to literally go across the Bay and have it with one of the most skilled FFS surgeons in the country... but that's just me... Anyway, the doctor in Sacramento that approved my revision has quit working with Kaiser, so I'm trying one last time to get an outside referral, it doesn't seem likely though. They'll probably try to send me to LA instead or something idiotic like that.

I had a similar experience when discussing my GCS results with Dr. Salim. When I told him I might consider a cosmetic revision of my vaginoplasty at our 1-year follow up, he looked at me like I was completely insane. I mean, really? The result is 'ok' but it's not great. So many big egos... I dropped it because it doesn't bother me as much and it wasn't worth the time to have another fight with the HMO.

Now I'm probably going to leave Kaiser and get the revision through another insurance company; it just seems easier. I haven't had my vaginoplasty results evaluated by another doc, but now I plan to as well.

Furthermore, ever since filing that grievance the MST, and even my other doctors treat me differently too. It's like I'm a problem and they don't want to see me or help me anymore. I had issues getting Rx refilled or seeing a dermatologist. My PCP is pretty unresponsive, even when I was asking about COVID19 screening. IDK. It might be nothing but it sure seems deliberate. It's not like I'm a particularly 'needy' patient either. I might email her about once a year or so. Anyway, I'm sick of it. KP is pretty behind the times in terms of trans care, IMO.

u/KP_TransitionJournal

Tue Sep 22 21:59:51 2020 UTC

(3 children)

Oof I'm sorry. So far I feel like male surgeons have huge egos, but maybe that's just me. I plan on getting GCS and ffs through SoCal Kaiser, and BA revision.

The team for Kaiser in west la have been great to me so far. I've seen Dr. Sharabi and Dr. Poh for GCS consults and Dr. Sharabi for breast, she seems to specialize in breast but is working with Dr. Poh for bottom surgery too.

I see Dr. Stacey Francis tomorrow too for FFS consult after two bad consults over the phone with other surgeons. It was easy to get new consults though, and quick too.

I haven't had any surgeries with them yet so I can't speak for after care but they've been caring and great to me so far.

I've filed grievances for Mental Health and I get that same vibe from my MH providers now. Like I'm a "problem patient" for wanting to advocate for myself.

I had really shitty insurance with Medi-Cal before (IEHP) so the bar was pretty low for good trans care. I only liked their mental health because you could look around and pick.

Aside from mental health, Kaiser has been the best trans care I've ever had, but again I haven't had any surgeries with them yet. Hope it continues well.

u/[deleted]

Tue Sep 22 22:12:52 2020 UTC

(2 children)

Kaiser has been the best trans care I've ever had,

Well, that was my experience too at first. Honestly, it was the first time an insurance company covered anything at all for me. But I figured out too late that the FFS surgeons were pretty substandard. I'd say my GCS is fine. Not a great result, but not bad either.

Their criteria for determining 'medical necessity' vs. 'cosmetic' is also some kind of opaque bullshit. Like they'd cover a breast augmentation for me even though I'm like a 34B... but they won't cover certain aspects of FFS, like a lip lift, even though I've had outside surgeons tell me that my upper lip is too long and outside the average female range. So, it's a fucking crap shoot.

I know people that are satisfied with the FFS they got through Kaiser, but I've personally never seen results that I thought were very good or on par with private doctors. There are a handful more dissatisfied patients on reddit too. My FFS was pointless. I hope yours is better though.

u/KP_TransitionJournal

Tue Sep 22 22:30:49 2020 UTC

(1 child)

Thanks. Do you regret getting ffs through them? Im on the fence about getting it done then having a revision later with another insurance if need be, only because it will be free through Kaiser.

I hear they are not too aggressive with things like forehead which is my major area of concern. Similar troubles as you, im trying to get my nose covered where they find it cosmetic, or at least during my last consult.

My last insurance covered everything, but all through one surgeon, ffs, ba, GCS, same guy, lowest bidder and there was no sense of cohesive care.

u/[deleted]

Tue Sep 22 22:39:39 2020 UTC

(0 children)

Yeah. Honestly I regret having it done at all. I should have researched and found other options. If you're in SoCal, you may be able to get Justine Lee at UCLA. I think she takes LA Care and even the Blue Shield plans offered through Covered CA. And her work is 1000x better than what I've seen from the KP docs that I've consulted with. I'm considering her as one of my revision options. She's not free with Covered CA insurance though because there's a 10% or 20% copay depending on the plan and the OPM. Looks like most folks who go to her have to pay about 5k out of pocket, but I'll put that shit on my credit card. lol If you want to send me a chat, we can talk more about this.

The problem with going with Kaiser just because it's free and then seeking a revision later is that it might not be considered 'medically necessary' anymore and you may end up just having to stick with whatever you get until you can save up for a private surgeon. I had to get a second AND third opinion before they would admit that Dr. Kleinberger's work was shit, and that I needed a revision. He kept telling me it was all just 'cosmetic' until I actually paid out of pocket for a consult with Dr. Deschamps-Braly who provided actual measurements and stats. The other problem is that revisions, as a rule, are usually more expensive than initial surgeries. You might have problems getting coverage just because of that, or you'll have to shell out more money later on.

I mean, Kaiser is pretty fucking user friendly sometimes. Referrals are all in house and there's no fighting to cover FFS. If you meet the criteria with one doc, you're set. Etc.... If you can manage to find a KP surgeon who's results don't suck, let me know? Some of the doctors they have are the absolute bottom of the barrel. If they just employed good surgeons, it would be perfect. If you have to fight them on anything though it's also a complete fucking nightmare. HMOs are just total dickheads.

u/KP_TransitionJournal

Tue Sep 22 03:05:39 2020 UTC

(3 children)

Are you in southern california? They have me scheduled with Dr. Poh. I know one person who went with metzler and had bad results and complications, but that can happen to anyone.

u/LunaSeydoux

Tue Sep 22 07:32:41 2020 UTC

(2 children)

I thought I would have Dr Poh, but I talked to Kaiser who informed me that my operation would be in Arizona. By going to Arizona I assume they mean to have me use Meltzer. After reading all the negative stuff on him makes me want to go elsewhere. I am in Georgia and it seems different Kaiser regions have their own preferences. Since I have to fly out and have adequate time off from work I wanted the whole procedure done at once instead of the two part plan (vagina vs labiaplasty).

I would prefer it to be done by a woman since I feel they would understand the importance of the procedure. And even though I have not seen samples of Poh I was a bit excited. I feel like a woman would understand when you get a vagina you might want the labia as well.

u/KP_TransitionJournal

Tue Sep 22 13:55:19 2020 UTC

(1 child)

Did you ask specifically for Dr. Poh? If not, you should. And if they say no then file a grievance explaining what your explained here.

What I've learned is that insurance will always try to get away with the minimum or cheapest solution and even tell you wrong things.

Definitely worth asking first, then trying out grievance route if they say no. Worst case scenario you still only have metzler, best case they send you to Dr. Poh.

u/LunaSeydoux

Tue Sep 22 14:27:10 2020 UTC

(0 children)

I thought that I may do that, but it is nice to have others recommend the same action. I figured if kaiser uses multiple doctors, you should be able to at least request the one you prefer. I think the confusing issue is the regional Kaiser groups all doing their own thing. I will make a strong request and hope for the best. Thanks for the advice, this is not something you just want anyone to perform.