Frequently Asked Questions

General FAQ | Member FAQ

Helpie FAQ

Plume Membership

  • How do I get the most out of membership?

    Thank you for being a Plume member. Here are the keys to getting the most out of your membership.

    • Talk to your care team. The real magic of Plume is that your care team is available directly through the Spruce app. Your care team is made up of care coordinators and your medical provider, all of whom have expertise in gender-affirming care. Message your care team anytime. No question or need is too small.
    • Get regular blood work. Get your labs done every 3 months. Your care team will remind you when it’s time to have bloodwork done. Blood work is done in-person at your local Quest lab and the cost is included in your membership.
    • Message your provider. You might be used to scheduling with your medical provider to discuss your prescription, progress, concerns, or lab results, but with Plume, that’s all done via messaging through the Spruce app. Message your medical provider and care team anytime you need anything.
    • Relax, we’ll remind you when it’s time to refill your Rx. And if something happens and you need a refill ahead of time, message your care team to discuss it.
    • Request letters of support. Just request a letter for name change, gender marker change, or a medical letter of support for surgery and we’ll have it to you within the week.**

    *If you live in NY/NJ, you are subject to some weird laws that require you pay for labs out-of-pocket. To offset this, NY/NJ membership costs $90 instead of $99 to cover the cost of labs.

    **We cannot provide behavioral health letters of support as we have no therapists on staff.

  • Having trouble logging into the Spruce app

    Sorry that you are having trouble logging in. Please try the tips below for resolution.

    Trouble with verification code

    • Can’t access phone to retrieve the verification code
      • Email Spruce support at support@sprucehealth.com from the email address associated with your Spruce account, describing your situation. Please include in your email the following information:
        • Your full name
        • A picture of your face next to your photo ID (e.g., driver’s license, passport, or government-issued ID)
        • The mobile number associated with your account
    • New phone number, can’t receive verification code
      • Email Spruce support at support@sprucehealth.com from the email address associated with your Spruce account, using the subject line ‘Request to update Phone Number’. Please include in your email the following information:
        • Your full name
        • A picture of your face next to your photo ID (e.g., driver’s license, passport, or government-issued ID)
        • Your old mobile number 
        • Your new mobile number
    • Verification code not received
      • Wait 5 minutes, then use the back arrow to return to the previous screen and select “next”. 
      • Wait 5 minutes, if you still don’t receive the code, restart your phone and try to log in again.
      • If you’re still having trouble, e-mail Spruce support at support@sprucehealth.com.

    Password reset

    • If you receive the error that your password is incorrect, follow the “Forgot password” link.
    • If you’re still having trouble logging in, e-mail Spruce support at support@sprucehealth.com.

  • How to cancel or suspend a membership

    Please message your care team in the Spruce app with your request. 

    You can suspend your membership for up to 6 months. After 6 months, you will need to pay for a new intake appointment to ensure your health information is current and accurate.

  • How do I update account settings in Spruce?

    If you need to update your name, pronouns, gender, address, or credit card, message your care team in the Spruce app.

  • Lab Work

  • How does lab testing work through Plume?

    All routine testing, including hormone monitoring and other blood tests, recommended for gender-affirming care is covered by the monthly membership fee.* Nothing extra needed!

    Without Plume, out-of-pocket labs can range from $150 – $500. You don’t have to worry about that with our membership.

    We order labs through Quest Diagnostics. They have many lab draw sites throughout the country. We place the order, and you go to the nearest Quest lab site to get your blood drawn. We let you know the results with recommendations via our secure app as soon as they come in.

    *New York residents are subject to a law that requires the patient to pay for labs out-of-pocket. To offset this, we have negotiated with Quest labs for reduced cost blood work. Plume will then reimburse New York patients by reducing their membership from $99 to $90.  The reduction in membership will cover the cost of labs with Quest. 

  • Blood work - when, how, and why

    Blood work (aka labs) are an important part of monitoring your health and progress. We recommend doing labs every 3 months. Your membership includes the cost of blood work which is conducted at your local Quest center*. 

    • Your care team will remind you when it’s time for labs. Instructions for scheduling will be in the reminder.
    • Find a Quest center and make an appointment.
    • Schedule using the name that matches your ID and we send them a note alerting them to your chosen name.
    • At your appt, tell them you are getting labs done for Plume Health. 
    • Your medical provider will contact you to discuss the results. 

    *If you live in NY/NJ, you are subject to some weird laws that require you pay for labs out-of-pocket. To offset this, NY/NJ membership costs $90 instead of $99 to cover the cost of labs.

  • Payment & Insurance

  • Do Medicaid or Medicare cover Plume services?

    Unfortunately, they do not. Remaining a cash-only practice allows us to be innovative and cost-effective in providing the care that folks want in the most convenient way possible. Depending on your program, you may pay for Plume out-of-pocket with no consequences. 

    Restrictions are based on the state you live in and the program you are enrolled in. Plume is not available for recipients of Medicare in any state or Medicaid in Colorado only. For more information about your specific restrictions, please contact your program directly.

  • Can I use insurance to pay for my Plume membership?

    We do not accept insurance for our monthly fees. Remaining a cash-only practice allows us to be innovative and cost-effective in providing the care that folks want in the most convenient way possible.  Our service is eligible for Health Savings Accounts (HSA) and we can provide guidance on how to use funds appropriately. Insurance may be used to cover the cost of hormone medication. Check with your insurance provider regarding coverage.

  • Is financial support available?

    We have partnered with several non-profits to provide need-based financial support for Plume members. Our HRT Access Fund provides 12 months of free gender-affirming hormone therapy and medications via Point of Pride. You can apply at https://pointofpride.org/HRT-Access-Fund/

    Our partnership with You Are Essential [https://www.youareessential.org/plume] raises funds for Black transgender folks to access care.

    Our “Pay it Forward”’ initiative donates directly to the Transformative Freedom Fund. Colorado residents can apply for financial support for medications and surgeries through the Transformative Freedom Fund, https://transformativefreedomfund.org

    For surgery-specific financial support around the country, you can apply to Point of Pride’s annual transgender surgery fund, https://pointofpride.org/annual-transgender-surgery-fund/.

  • How does the cost of Plume compare to out-of-pocket or insurance?

    We made a cost comparison chart to help you determine if Plume is right for you.

  • How much does Plume cost?

    Membership is $99 per month. If you live in NY or NJ, the cost is $90, discounted to offset the out-of-pocket cost of labs. You are charged the same date every month to the credit card we have on file. If you need to update your credit card or the date you are charged, message your care team.

    You cannot use insurance, medicaid, or medicare to pay for Plume. We use a direct payment model to keep costs low. But if you have an HSA, check if you can be reimbursed.

  • How do I update my credit card?

    It’s easy! Just message your care team with your new card number, expiration date, three digit code, and if your billing address has changed.

  • All about meds

  • How do I change my dose?

    You can discuss it with your provider anytime! Send a message to your provider in the Spruce app.

  • How do I perform an injection?

    Injections can be a bit tricky at first, but we’re confident you will get the hang of it with practice. Message your care team in Spruce to learn or be reminded of how to perform either a subcutaneous or intramuscular injection. We’re always here to support you.

  • How do I get an Rx refill?

    Relax, your care team will remind you when it’s time to refill your Rx. You will get a message in Spruce that a new refill is being sent either to your local pharmacy or our delivery pharmacy. If anything happens and you need a refill sooner than expected, reach out to discuss it with your care team.

  • Plume Services

  • Does Plume provide behavioral health?

    No, but we do encourage a relationship with a behavioral health provider for continued support as we believe this is a valuable resource for all people. 

    If needed, we will help find a local therapist in your area that is competent in gender-affirming care or help connect you with a remote therapist who can be seen from the comfort of your own home via video, text or phone such as:

    https://www.pridecounseling.com – queer/trans specific

    https://www.betterhelp.com – not queer/trans specific but sensitive

    https://www.marigoldhealth.com – not queer/trans specific but sensitive

  • Does Plume provide gender-affirming surgery?

    We do not provide gender-affirming surgery, but we do provide letters of support for surgery for both members and non-members. Letters of support are included in the price of membership or as a one-time service. We will also help navigate the process by providing a list of surgeons, referral if necessary, and guidance from our care team.

  • Does Plume provide letters of support for gender-affirming surgery?

    Yes! We provide letters for both Plume members and non-members. If you are a Plume member, letters are included in your membership. If you are not a member, you can pay a one-time fee of $150 for an appointment with one of Plume’s medical providers, access to our care team for resources and support, and a guaranteed one week turnaround time to issue the letter. If you need a letter from a behavioral health professional, unfortunately we don’t provide those. 

  • Does Plume provide letters for name or gender marker changes?

    Yes! To change the name or gender marker on your identification documents (driver’s license, social security card, passport, birth certificate), you often need a letter from your treating medical provider or a form signed by them. You must be a member with Plume to receive name and gender marker letters, we do not provide one-time letters for name or gender marker change.

    Here are some great resources:

    http://www.namechangeproject.org (Colorado only)

    https://transequality.org/documents (national database)

    https://transgenderlawcenter.org/resources/id (national database)

  • New York and New Jersey residents have a different membership, here’s how

    New York and New Jersey are beautiful states, but have strange laws about paying for laboratory services. 

    Your Plume membership includes the cost of labs. Patients in New York and New Jersey are legally required to pay for lab services out-of-pocket. We have arranged a low rate with Quest labs where you pay out of pocket and we reimburse you for the cost by discounting your monthly membership.

    Monthly membership for New York and New Jersey patients is $90, for all other states it is $99. This way Plume members in NY and NJ will pay the same average of $99 per month as all other members. 

  • Appointments for Members

  • How do I make appointments with my provider?

    You may be used to scheduling with your medical provider and meeting in person. We do things differently at Plume. No long waits or travel time. After your first live video appointment, you can simply message your care team and medical provider directly through the Spruce app. Whether you have questions or concerns, your care team is available every day.

  • Shipping & Delivery

  • How do I switch to delivery?

    Plume works directly with a delivery pharmacy. Switching to delivery means you only contact us with issues and there’s no travel or wait time. Your care team will message you when it’s time to place your new Rx order. Here’s what you need to know:

    • We do not deliver injectable estradiol.
    • You cannot use insurance to pay for delivery prescriptions.
    • You pay out-of-pocket and our pricing is competitive with goodrx (coupon discounted medication).
    • Your legal name will be on the package. We’re very sorry about this.
    • It takes 4-7 days to receive your prescription.
    • Shipping and handling is $6.
    • You can switch back to a local pharmacy any time. 

    If you want to switch to delivery, message your care team.

    Get Started With Plume