Lake Willeford, 34, lives in rural Texas and was raised in a Southern Baptist family. Since he was 6 years old, Willeford knew he was a trans man but kept it to himself until he came out in 2021. “I wish I would’ve come out as a trans man a long time ago. Ultimately, I was afraid to be myself,” he said. “I realized we only get one life and there’s no point hiding.”
When Willeford started hormone therapy, his closest option for a doctor required a two-hour drive. Then he found LGBTQ-focused telehealth company Folx Health. At the time Folx was cash-pay only, so Willeford had to pay a membership fee of $139 per month, and about $100 for testosterone every three months.
“It was a necessity for me, so I prioritized it and set [the money] aside,” he said. “I’m middle class and make decent money, but I have kids, and $130 a month was a lot.”
While Willeford was able to manage the cost of Folx, many people in similar positions can’t. Compared to the general U.S. population, transgender people are more likely to face economic barriers, which makes paying for care out of pocket difficult.
Rose, a 22-year-old trans woman (who asked to be identified by first name only), is a college student who works as a package handler for FedEx. She tells Fast Company via online chat that when looking for a provider for hormone therapy earlier this year, she was shocked by Folx’s prices, which were $140 per month and $230 for hormones. Her understanding was that market rates were about $80. “It was overpriced and unreasonable,” she says.
This past week, however, Folx took a step toward making its care more affordable by accepting insurance from a few companies, among them Cigna, Evernorth, and Blue Shield of California—allowing it to reach the LGBTQ members among its collective patient pool of 7.5 million. Insurance now covers clinical visits, lab work, and hormone treatments, and members can pay their copay instead of the Folx membership fee (which the company has lowered to $39 per month). As of this writing, Folx says 12% of its visits are covered by insurance, and medication coverage has grown from 5% to 25%.
Insurance coverage is a goal that CEO Liana Douillet Guzmán, who joined the company in 2022, says Folx has been working toward. When the company launched in 2020, she says it was focused on building a platform to provide care to people who might not have other options and building a network of licensed clinicians.
But Guzmán says insurance was one of the main reasons Folx lost members. “When we lost people it was almost always because they had insurance and couldn’t justify paying out of pocket when their insurance would cover care elsewhere,” she says.
For many startups, Guzmán says, working with insurers is a process that can take up to a year to establish. But Folx’s own patient data highlighted the need to act: While 78% of Folx’s members said they didn’t have access to care, 71% said they actively avoided seeking healthcare, while 15% were looking for out-of-network care. In response, Guzmán says, “We were able to fast-track our conversations with insurance.”
Krishna Ramachandran, SVP of health transformation and provider adoption at Blue Shield of California, noted that Folx’s services matched its members’ needs. “We have a very diverse community and we want to make sure our care matches it,” he said. “We were impressed with Folx’s inclusive, thoughtful, high-tech and high-touch services.” He noted that the process of onboarding Folx took about two months.
Willeford is excited that some of his care at Folx will be covered by his insurance and that Folx will now be more accessible to others, noting, “Folx has changed my life.”
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