FRUSTRATING NEWS !!

[BettyBoop 28]

I have faith !!!! Look at my ticker... I have been dropping weight like bad habits !!! 20 more pounds and I am on the table...

Yeah baby! You can do it!! :thumbsup:

[longer-life 139]

. I have been dropping weight like bad habits !!!

:rofl:

[marypenny 3]

As a Kaiser member (and the wife of a retired orthodontist and one who dealt with insurance/***'s for 20 years) may I just suggest that Kaiser is doing their level best to bully you. Yes, losing 10 pounds a month for 4 months running is feasible, but it's not very realistic. Everyone, even us sleeved folks, hit plateaus! They can not disqualify you from their program because you failed it once before & have gained/regained weight. They can & do gently mis-represent their guidlelines and they do their best to gently intimidate you into losing weight without surgery. But if you read your plan very carefully, and you speak with Member Services you will find that the Options Program (you see the word Options is plural? That includes their liquid program you see??) is filled to bursting with obese folks. They can't afford to do surgery on them all, quite frankly. That's what an *** is... health Maintenance program...they want you as healthy as they can get you without the expense of surgery. Remember that Kaiser is a business. They are in business... and that means that they have to collect more in monthly premiums from all their patients than they pay out for operating costs...building upkeep, salaries, operating rooms, maintenance, etc. So they have to "push out into the future" any procedures they can. They do it so they can stay in business financially. They must do things legally, of course. And there is the key.

That means that you have a legal right to the surgery, too. They have to obey the laws, even if it costs them money. You have to be pro-active about your care. Talk to Member Services. Mention that you feel you are being pushed aside. If you have co-morbidity issues, mention them. They record every single conversation you have with them, so do not ever say anything that you know to be false. You have to "play by" the rules too. Member Services is your advocacy voice and you need to talk with them. You'd be amazed how quickly you can get a needed referral from your PCP if you mention that you are unhappy with the slowness and think you'd better talk with MS.

Obviously, I do have Kaiser. I discovered that here in So Cal I could expect a wait of 10-11 months (although I did hear one rumor about someone who got into Fountain Valley for surgery in just 4 months). Believing the 10-11 mo. wait, I chose to go out of network and pay the $15K on my own. With my deductible at $6K that made the surgery $9K extra and I will have lost 100 pounds by the time they would consider me for surgery. Am I glad that I did it out of network, yes! I have it done now and I am 5 days post op. I've lost 20 pounds, including pre-op diet and I'm very happy. I did it on my time schedule and when I was ready for it.

But Kaiser will do your surgery if you continue to work with Member Services.

Hang in there. Hope these words of encouragement helped!

Mary

[Driver Deb 10]

As a Kaiser member (and the wife of a retired orthodontist and one who dealt with insurance/***'s for 20 years) may I just suggest that Kaiser is doing their level best to bully you. Yes, losing 10 pounds a month for 4 months running is feasible, but it's not very realistic. Everyone, even us sleeved folks, hit plateaus! They can not disqualify you from their program because you failed it once before & have gained/regained weight. They can & do gently mis-represent their guidlelines and they do their best to gently intimidate you into losing weight without surgery. But if you read your plan very carefully, and you speak with Member Services you will find that the Options Program (you see the word Options is plural? That includes their liquid program you see??) is filled to bursting with obese folks. They can't afford to do surgery on them all, quite frankly. That's what an *** is... health Maintenance program...they want you as healthy as they can get you without the expense of surgery. Remember that Kaiser is a business. They are in business... and that means that they have to collect more in monthly premiums from all their patients than they pay out for operating costs...building upkeep, salaries, operating rooms, maintenance, etc. So they have to "push out into the future" any procedures they can. They do it so they can stay in business financially. They must do things legally, of course. And there is the key.

That means that you have a legal right to the surgery, too. They have to obey the laws, even if it costs them money. You have to be pro-active about your care. Talk to Member Services. Mention that you feel you are being pushed aside. If you have co-morbidity issues, mention them. They record every single conversation you have with them, so do not ever say anything that you know to be false. You have to "play by" the rules too. Member Services is your advocacy voice and you need to talk with them. You'd be amazed how quickly you can get a needed referral from your PCP if you mention that you are unhappy with the slowness and think you'd better talk with MS.

Obviously, I do have Kaiser. I discovered that here in So Cal I could expect a wait of 10-11 months (although I did hear one rumor about someone who got into Fountain Valley for surgery in just 4 months). Believing the 10-11 mo. wait, I chose to go out of network and pay the $15K on my own. With my deductible at $6K that made the surgery $9K extra and I will have lost 100 pounds by the time they would consider me for surgery. Am I glad that I did it out of network, yes! I have it done now and I am 5 days post op. I've lost 20 pounds, including pre-op diet and I'm very happy. I did it on my time schedule and when I was ready for it.

But Kaiser will do your surgery if you continue to work with Member Services.

Hang in there. Hope these words of encouragement helped!

Mary

It is fascinating that you posted this today... I contacted member services Friday night and told them that I felt I was being pushed aside and that I felt they were delaying services and that I would be filing a grievance with the DMHC who oversees Kaiser. I got a response back in less than an hour. They stated that they were forwarding my email on to a representative who would be looking into the matter and that they want to do everything in their power to make sure my needs are being met. LOL I knew a threat of a grievance with the dept. of managed health care would get their attention !!! I will let you all know how it works out, and how long it takes to get it worked out.

[Jinjin 21]

GOOD FOR YOU!!!!!!!! Dont give up..

[BettyBoop 28]

As a Kaiser member (and the wife of a retired orthodontist and one who dealt with insurance/***'s for 20 years) may I just suggest that Kaiser is doing their level best to bully you. Yes, losing 10 pounds a month for 4 months running is feasible, but it's not very realistic. Everyone, even us sleeved folks, hit plateaus! They can not disqualify you from their program because you failed it once before & have gained/regained weight. They can & do gently mis-represent their guidlelines and they do their best to gently intimidate you into losing weight without surgery. But if you read your plan very carefully, and you speak with Member Services you will find that the Options Program (you see the word Options is plural? That includes their liquid program you see??) is filled to bursting with obese folks. They can't afford to do surgery on them all, quite frankly. That's what an *** is... health Maintenance program...they want you as healthy as they can get you without the expense of surgery. Remember that Kaiser is a business. They are in business... and that means that they have to collect more in monthly premiums from all their patients than they pay out for operating costs...building upkeep, salaries, operating rooms, maintenance, etc. So they have to "push out into the future" any procedures they can. They do it so they can stay in business financially. They must do things legally, of course. And there is the key.

That means that you have a legal right to the surgery, too. They have to obey the laws, even if it costs them money. You have to be pro-active about your care. Talk to Member Services. Mention that you feel you are being pushed aside. If you have co-morbidity issues, mention them. They record every single conversation you have with them, so do not ever say anything that you know to be false. You have to "play by" the rules too. Member Services is your advocacy voice and you need to talk with them. You'd be amazed how quickly you can get a needed referral from your PCP if you mention that you are unhappy with the slowness and think you'd better talk with MS.

Obviously, I do have Kaiser. I discovered that here in So Cal I could expect a wait of 10-11 months (although I did hear one rumor about someone who got into Fountain Valley for surgery in just 4 months). Believing the 10-11 mo. wait, I chose to go out of network and pay the $15K on my own. With my deductible at $6K that made the surgery $9K extra and I will have lost 100 pounds by the time they would consider me for surgery. Am I glad that I did it out of network, yes! I have it done now and I am 5 days post op. I've lost 20 pounds, including pre-op diet and I'm very happy. I did it on my time schedule and when I was ready for it.

But Kaiser will do your surgery if you continue to work with Member Services.

Hang in there. Hope these words of encouragement helped!

Mary

What you're writing about Kaiser applies to ALL insurances. Not just Kaiser. And the wait to get the surgery is that Kaiser makes all of us go through the Option's Plan. And it is a wonderful plan. they prepare you for the surgery and what happens afterwards. I see and read about so many people that have this life changing surgery and they are totally lost afterwards! I'm so happy that I did go through the classes. Kaiser has the best plan out there IMO for this life changing surgery. The reason they have it, is so you'll be successful long term in your weight loss goals.

I started the Options classes June 1st. I finished them in August. I also lost the required 10% weightloss they ask for, for my safety. Plus more. If someone doesn't lose the weight before surgery, they're not going to be very successful in keeping it off long term. It is no rumor that people that go through the Option's Plan at Kaiser have their surgeries in 4 months, IF that is the route you want to go. I am having my surgery tomorrow and this is the Kaiser in So CA. So I don't know who told you it was an 11 month wait for the surgery.

[Driver Deb 10]

What you're writing about Kaiser applies to ALL insurances. Not just Kaiser. And the wait to get the surgery is that Kaiser makes all of us go through the Option's Plan. And it is a wonderful plan. they prepare you for the surgery and what happens afterwards. I see and read about so many people that have this life changing surgery and they are totally lost afterwards! I'm so happy that I did go through the classes. Kaiser has the best plan out there IMO for this life changing surgery. The reason they have it, is so you'll be successful long term in your weight loss goals.

I started the Options classes June 1st. I finished them in August. I also lost the required 10% weightloss they ask for, for my safety. Plus more. If someone doesn't lose the weight before surgery, they're not going to be very successful in keeping it off long term. It is no rumor that people that go through the Option's Plan at Kaiser have their surgeries in 4 months, IF that is the route you want to go. I am having my surgery tomorrow and this is the Kaiser in So CA. So I don't know who told you it was an 11 month wait for the surgery.

I have done all the required classes and I have lost well over my 10% but they told me they wanted me to lose more... I was reactivated in the program at 290, I now weigh 256 and they want me at 235. That is unreasonable !!! That is why I am raising hell... I have to lose 55 pounds? I have NEVER weighed 550 pounds !!!

I agree that all the classes are great info and I obviously am sticking to the diet, I have lost 34 pounds... which is what someone who weighs 340 should lose !!!

[marypenny 3]

Hello Betty,

Glad to hear you have succeeded in the Options Program with Kaiser. I was told 10-11 mo. by the Options gal at the Downey facility. I believed her & paid for it out-of-pocket in order to have it done before Aug. of 2012. But you know, it's doing what you are supposed to do that makes for success. I wish you the very best! Mary

[BettyBoop 28]

I have done all the required classes and I have lost well over my 10% but they told me they wanted me to lose more... I was reactivated in the program at 290, I now weigh 256 and they want me at 235. That is unreasonable !!! That is why I am raising hell... I have to lose 55 pounds? I have NEVER weighed 550 pounds !!!

I agree that all the classes are great info and I obviously am sticking to the diet, I have lost 34 pounds... which is what someone who weighs 340 should lose !!!

I'm sorry you're having to go through this. Perhaps there are health reason's why? I know I was told to lose 10% and I went way past that.

And the surgeon told me to continue to lose weight. It makes it all for an easier surgery for him to do, and for us for an uneventful surgery and easier recovery....

So good luck in any case...

[prvtdetdave 4]

i lost more than 45 pounds in three months by following the high Protein slim fast meal plan. i would drink two shakes a day. have 3, 100 calories or less Snacks and then a meal with 500 calories or less. it worked great for me and i wasnt hungry all the time thanks to the snack inbetween shakes. you can do it!

Slim Fast? Last I looked there was little to no protein in slim fast.

[Sassygirl06 962]

Slim Fast? Last I looked there was little to no Protein in slim fast.

they have a high protein slim fast now. my nut and surgeon recomended it. worked really well. I would buy the powder stuff and use it with almond milk for the lower calories and carbs. you gotta be careful with the almond milk though at first because it will make you run to the toilet with diahrea if you drink to much of it without being used to it first.