Keojampa FFS Insurance coverage?

10
u/shawnanotshauna
Tue Dec 22 00:32:50 2020 UTC
(27 comments)

Has anyone successfully gotten their FFS covered under Keojampa?

So far I have consulted with Satterwhite and I really like the align surgical team, and it seems like getting the surgery covered under insurance will be fairly straightforward with them handling the brunt of the work/direction on what to do to gain coverage.

I was wondering if Keojampa has a similar process.

Also I am a software engineer for a tech company that outlines trans FFS explicitly in their employee health insurance.

Thank you(:

all 27 comments


2
u/[deleted]
Tue Dec 22 00:53:32 2020 UTC
(9 children)

A lot lot lot of girls have

1
OP
Tue Dec 22 01:05:14 2020 UTC
(8 children)

Yea I’m just more looking at the process/difficulty and did they have to pay up front and get a reimbursement

2
Tue Dec 22 01:38:11 2020 UTC
(7 children)

Uhm make a consult, see Keojampa and have his insurance coordinator submit documentation. You’ll most likely not get approved and you’ll have to fight it with your insurance company. It took me about 3 months to get Keojampa approved even though I didn’t go to him. I’d put down the 5k deposit and get you surgery scheduled before waiting for approval. The 5k will be reimbursed or go to deductible after surgery. His office will only submit paperwork you still have to do a lot of the heavy lifting and host waitlist for surgery is over a year. Tbh I’d prob also set up consults with Jumaily, Rodman, mardirrosian, Rolfes as they all also work with insurance but have much shorter waitlists. Keojampa works with trans women and cis people so he’s always booked. If you on the Facebook ffs group you’ll find better information then you will off Reddit tbh.

1
OP
Tue Dec 22 02:51:20 2020 UTC
*
(6 children)

Did you not get approved initially because he’s out of network?

Im not sure exactly how it works with insurance. I just know my company offers ffs through our insurance, it lists facial bone reconstruction, rhinoplasty, jaw contouring, trachea shave (which I’ve already had), as well as other things as approved procedures for trans patients

And I am considering doing a consult, I just was trying to get some info before that because it’s $150 for a consult I believe is what I read on his page.

1
Tue Dec 22 05:41:12 2020 UTC
(5 children)

No he was out of network for Aetna. I had a PPO through Aetna T-Mobile. PPO allows you to go to any doctor in or out of network and my out of network maximum was 3000$. I was not approved initially but after an appeal my companies insurance coordinator was able to get it approved a few months later.

1
OP
Tue Dec 22 07:34:17 2020 UTC
(4 children)

Oh I see, so you wernt approved until your company stepped in. Thats kind of frustrating, especially since I’m assuming T-Mobile, like many tech companies, tends to use trans friendly health plans

What made you end up going with someone else over Keojampa? if you don’t mind me asking

1
Tue Dec 22 15:15:11 2020 UTC
(3 children)

His wait and I didn’t have the 5k also Covid. Though I regret going to Dr Z and I’m now going to Deschamps-Braly for revisions.

1
OP
Tue Dec 22 15:21:32 2020 UTC
(2 children)

Im sorry to hear that:/ DB seems like a good surgeon though, and I’m sure he will do a great job

1
Tue Dec 22 16:32:14 2020 UTC
(1 child)

Ohh yeah he seems awesome and he works with Starbucks insurance now.

1
OP
Tue Dec 22 17:19:25 2020 UTC
(0 children)

Oh wow that’s great! I used to work for Starbucks in college lol

I tried so hard to get in with them as an IOS dev for their Phoenix Tech office, but I couldn’t get an interview unfortunately

2
u/PinkWhiteAndBlue
Tue Dec 22 02:07:16 2020 UTC
*
(8 children)

I have surgery with him jan 2022 and it was just approved by my insurance 👌 pretty simple process

He is out of network with everyone though, so unless your insurance will treat that as in network you'll probably need to be reimbursed

2
OP
Tue Dec 22 03:05:03 2020 UTC
*
(6 children)

Thank you!

What insurance do you have if you don’t mind me asking?

Also so you have to pay the entire $50-60k upfront and then be reimbursed?

It’s not like this is a deal breaker for me, but it would require me likely moving out of Los Angeles or seriously downgrading my living situation to save up the money within a year, and when I weigh that against someone like Satterwhite who is in network with my insurance, it’s a big decision to consider.

2
Tue Dec 22 03:42:00 2020 UTC
(5 children)

I have anthem ppo and work at a big tech company that specifically has really good trans coverage.

And it's basically up to your insurance if youll be paying full out of pocket to get reimbursed. Mine should be covering it for me, but they haven't signed for that yet.

2
OP
Tue Dec 22 04:27:26 2020 UTC
(4 children)

Wow we are like the same boat. I also use anthem PPO, and work for a tech company that has trans coverage.

2
Tue Dec 22 04:53:19 2020 UTC
(3 children)

Oh hey that's super cool! It will probably be about the sane process then 😅

1
OP
Tue Dec 22 07:29:03 2020 UTC
(2 children)

Let’s hope it is! ❤️

So just to verify, it’s out of pocket at first, but then our insurance should kick in and reimburses the amount

1
Tue Dec 22 08:24:38 2020 UTC
(1 child)

Well idk if you're in the exact same situation as me, my company actually funds their trans coverage so that it's always considered in-network.

If your insurance doesn't do this, it will be treated as out of network and you'll need to pay out of pocket first (or take out a loan and pay it off right after). If your insurance does count it as in-network then they should pay it upfront.

Although on that note, he requires a $5000 deposit regardless of insurance.

2
OP
Tue Dec 22 15:20:20 2020 UTC
(0 children)

Thank you for the info!

2
u/Darkbyte
Fri Dec 25 18:31:55 2020 UTC
(0 children)

Hi, can you dm me what tech company you work for? I'm a software engineer and am currently applying everywhere trying to find a new job that will cover ffs. Thank you 🙏🏻🙏🏻

2
u/lzgudsglzdsugilausdg
Fri Jul 28 10:41:11 2023 UTC
(4 children)

Old thread but has anyone beenn able to do it through premara? I saw it was only 50 percent coverage after a limit even though there was an out of pocket maximum?

2
Tue Sep 12 22:07:57 2023 UTC
(3 children)

It depends a lot on the employer and whether it's a self-funded plan (generally big companies like Microsoft, Amazon, etc) or if it's a small company on a generic Premera plan. I'm currently going through a generic Regence plan and they are trying to get away with covering ~15% and I'm currently working on appeals.

1
Thu Jan 4 03:49:47 2024 UTC
(2 children)

Hello, it looks like Dr Keojampa's office sent an LOA to my premara plan (big tech) but they rejected it by saying it was out of network. Should I now appeal with strong reasons why they should approve it? I'm not sure what are the best reasons to put here.

1
Thu Jan 4 19:38:35 2024 UTC
*
(1 child)

My experience thus far has been:

  • Pre-approval went through
  • Letter of agreement was rejected
  • Regence gave me a bad estimate of the covered amount (the numbers their customer service gave me was more like 15-20k covered, but it was clear the customer service didn't know what the actual numbers would be)
  • I ended up paying the full amount and Regence only reimbursed ~$10.5k out of ~$80k
  • Regence didn't budge at all through many complaints and appeals
  • They did, however, point out that the procedure was at a hospital considered in-network, and that makes it applicable to the No Surprises Act (can't balance bill without consent at an in-network hospital)
  • I'm currently working on trying to get refunded by Keojampa via the No Surprises Act (seems health insurance companies had a hand in writing that law because the uncovered cost gets passed onto the provider when it is invoked, so Keojampa will be forced to accept the covered ~$10.5k as full payment and refund the rest)

Since you say you are at a big tech company, you can try going through HR/whoever manages your health insurance plan and see if they are able to do anything about the coverage. Big companies with self-funded plans potentially have say in what gets covered.

If your company isn't able to do anything about it, you are pretty much at the mercy of the insurance company (and they will only cover a small % of what Keojampa charges).

Your only other hope past that would be that Keojampa's office is still poorly organized like when I was interacting with them and they schedule you at an in-network hospital without making you sign a balance billing consent form. I'm not sure this route actually works since I'm still waiting to hear back from my No Surprises complaint, but from what I read of the law it should.

Edit: Also something that was not clear to me originally, but the facility/anesthesia is a separate bill from Keojampa. So make sure that the facility it is scheduled at is in-network regardless of whether you end up having to sign balance billing consent for Keojampa!

1
Sun Jan 14 07:54:03 2024 UTC
(0 children)

I'm basically at your third bullet point, and i sent out the appeal. I'm very unsure about paying the full price, but I do believe the hospital is also in network for me.

1
u/[deleted]
Tue Dec 22 00:53:14 2020 UTC
(2 children)

OMG I'M LOOKING AT BOTH OF THOSE SURGEONS TOO!!! def going to bookmark this and GET THE SCOOP

2
OP
Tue Dec 22 01:04:01 2020 UTC
(1 child)

Well happy we get both our questions answered at the same time 💁🏻‍♀️

2
Tue Dec 22 01:06:37 2020 UTC
(0 children)

YES TWINSIES