On FOLX Costs

Our current healthcare system incentivizes insurance companies to skimp on care and providers to make decisions on behalf of patients based on how they get paid. FOLX is different.

FOLX colors

Our current healthcare system is locked into an insurance scheme that incentivizes insurance companies to skimp on care and providers to make decisions on behalf of patients based on how they get paid. FOLX is different.

FOLX doesn’t accept insurance, and is a “self-pay” service. Hear us out.

FOLX costs in cash are generally less than what most people pay out of pocket for co-pays and deductibles. The average deductible for 2020 was $1,644. That means paying for insurance, but paying another ~$1,644 before insurance will actually cover anything. We know.

By charging up front, without insurance, FOLX is able to provide:

  • Medication & lab pricing, with no hidden costs, shipped straight to members’ doors
  • Simple, hassle-free services delivered straight to your home (saving time and money)
  • Full member agency over choice in care, medication, services (without interference from bureaucratic policy rules)
  • Access to services specific to the queer and trans community that aren’t always included under insurance because of heteronormative and cisnormative practices that have built the current insurance systems

We ship medications to give members control over price.

We can’t guarantee the cost of medications at pharmacies, we can’t guarantee pharmacy inventory, we can’t guarantee insurance coverage of pharmacy costs, we can’t guarantee queer-and-trans-friendliness at a pharmacy. That’s a lot of unknowns. What we can guarantee are our medication costs. FOLX has pre-negotiated rates for our prescription products with our mail-order pharmacy vendor in order to give one clear answer on medication cost. We believe the convenience of set prices and direct-to-your-door shipping come at the highest value. 

We build in cost for clinical time into our member price.

Similar to medication cost, there are a lot of unknowns with in-person visits: will there be a waiting list for an appointment? Will the staff be queer-and-trans friendly? Will the staff be queer-and-trans competent? How much will the visit cost? How much of the visit cost will insurance cover? How far is the visit from where I live? Will I have enough time in the appointment to ask what I want to ask? At FOLX, we build clinical time with our queer-and-trans providers into our membership costs to ensure access, not just generally, but through unlimited messaging with clinicians, and dedicated 45-minute appointments to ensure we’re not rushing anyone in-and-out. We believe the convenience, control, and safety are worth it.

For those with insurance, FOLX membership costs are still HSA/FSA eligible.

While most of our members will be paying in cash, those with Health Savings Account (HSA) or Flexible Spending Account (FSA) plans under their insurance can still absolutely use those to cover their FOLX costs.

We understand that our choice to cut the insurance middlemen may make our services too expensive for some. 

We believe wholeheartedly that healthcare is right and not a privilege. And when the day comes when everyone has equal access to health insurance, and that health insurance covers all of the health care that queer and trans people need, we will be delighted to accept insurance.

Today, however, most queer & trans folx experience a unique system of barriers that makes great care inaccessible. The current system is confusing, expensive & discriminatory. This is made worse by an insurance system that often does not cover essential queer & trans services such as Gender Affirming Surgery or Reciprocal IVF.

Add to that, the fact that many doctors won’t prescribe the medications we need, don’t understand our bodies and if they do, they require many layers of unnecessary gatekeeping.  And insurance compounds the problem.

Much of the care we want isn’t even covered, and when it is, we often have to go through elaborate pre-approval processes and bureaucratic barriers. And even if we get through all of that, our medications may still get changed at the pharmacy without our consent, and on top of that we may end up paying most of the costs out of pocket anyway because of high co-pays and deductibles.

We made FOLX a self-pay service so we could restore a sense of control for our members. 

By avoiding health insurance, our members control every aspect of their care. They choose their medications and services through our informed consent model. And in most cases, they end up paying almost the same as if they had insurance. 

When it comes to critical decisions like HRT, family creation, and sexual health, we believe that getting control back from the system is worth every penny.