Kaiser Coverage Of Revision Surgery

[CamarilloCA 41]

Hi there, I was wondering if anyone who has Kaiser Permanente insurance got them to cover revision surgery from lap band to a gastric sleeve.

I qualified for the lap band surgery through Kaiser, but I opted to self-pay because they wanted me to do the Options program before the surgery, which would have meant driving into Los Angeles once a week for six months, and I couldn't do that. I wanted to have my surgery performed by a surgeon in Ventura, which is much closer to where I live.

Anyway, I paid to have the lap band surgery and got the lap band in April, 2008, and I had a small amount of weight loss at first, which eventually came back. My band was tightened nearly to the max, and I would throw up at nearly every meal. They told me that my metabolism is very low, which would make it hard to lose weight, and I have found that to be true and try to exercise when I can.

Lately, I have a never-ending stomach ache and am trying to see if Kaiser will remove the lap band and approve the vertical sleeve instead. The endoscope apparently showed that there is no erosion, slippage, or ulcers, but it is possible that I have scar tissue around my band or that I may have a hiatal hernia. I am trying to get a upper G.I. to be able to learn more about my stomach pain, but I have to wait about a month before I can get an appointment with my PCP.

Has anyone here with Kaiser Insurance had revision surgery approved? Can you tell me what your experience was? Did Kaiser make you wait a long time until your revision surgery?

Thanks very much for any advice or assistance.

[thebionicbroad 127]

Camarillo,

Kaiser SoCal did my band to sleeve revision on December 13th. I was a self-pay for the band, and was in the same situation as you with the constant vomiting. I had a slight slip, but no erosion. Even with the scar tissue from the band, I had the band removed and revision done in the same procedure.

[CamarilloCA 41]

Hi Bionic, thank you so much for responding. You have given me hope now. Can you tell me some more information about how you went about getting them to cover it? Did you have to have a BMI over 40 or over 30 with some other serious condition? Did you have pain and go to your PCP? Did they make you go through a program of theirs first? Sorry for all the questions, but I am anxious about this. I have stomach pain all the time and can't imagine living with it for six months while I fight for them to cover this.

[Ms skinniness 3,003]

I am a kaiser patient with the sleeve. Here is my suggestion, call up Kaiser and tell them you are in so much pain that you need to see your primary ASAP. If they say there are no open appointments, have the receptionist call your PCP's office and have them fit you in. There are ways to get around everything, just be the sqeaky wheel and you will get what you need. If you have to do the Options program, it is now 12 sessions instead of 6 months. Best of luck, let me know what happens.

[thebionicbroad 127]

I had a BMI of 36, with no co-morbidities. I had the vomiting and couldn't eat anything but sliders. My PCP referred me to a bariatric surgeon, who wanted to get the band out post-haste. I had upper GI but no classes. Between referral to bariatrics and revision was 2 weeks.

[CamarilloCA 41]

Thanks so much, Dorrie! I will do that on Monday.

Thank you, Bionic! That is so awesome that you could do it all in two weeks. That's very reassuring. I hope I am as lucky as you were. Thanks again.

[sleeve 4 me 910]

There was a lady in a recent options class I spoke at that was having band to sleeve surgery and Kaiser was covering it.

[CamarilloCA 41]

Thank you, Sleeve4me. I just hope that they don't make me go to the Options Class in Los Angeles because that is too far to drive for me.

I appreciate all the help. I will update this thread to let you all know what happens. I so appreciate the information and support. I am just so anxious and upset, and my abdominal pain won't seem to let up.

[CamarilloCA 41]

I am a kaiser patient with the sleeve. Here is my suggestion, call up Kaiser and tell them you are in so much pain that you need to see your primary ASAP. If they say there are no open appointments, have the receptionist call your PCP's office and have them fit you in. There are ways to get around everything, just be the sqeaky wheel and you will get what you need. If you have to do the Options program, it is now 12 sessions instead of 6 months. Best of luck, let me know what happens.

Hi Dorrie! I called, and they fit me in at 3:30 p.m. today. Fingers crossed that I get a referral to Barriatrics. Thanks for the encouragement!

[Ms skinniness 3,003]

Camarillo`` you will get the referral. Play it big because it is big! So happy you got an appointment.

[CamarilloCA 41]

Hi everyone, I went to the doctor yesterday, and he said that he did send in a referral for an Upper G.I. and to bariatrics, but he has no way of knowing what happens from here. His nurse told me that it is sent to an "authorization department."

I'll update this thread when I hear something. All in all, Kaiser has been good insurance. I'm hopeful that I can get this thing out of me soon and start my new life with the sleeve.

[CamarilloCA 41]

Hi Everyone, it looks like I have been referred to Barriatrics now, and my upper G.I. was covered by Kaiser. They didn't see a slip or erosion or any ulcers, but I still have pain so I don't know what is going on. The radiologist did say that he can see reflux. I think that Kaiser will cover the removal of the lap band, but I don't know yet if they will approve a revision to gastric sleeve. I am anxious, but all I can do is sit and wait now until I hear something.

The receptionist at my surgeon's office seems a little annoyed with me because I've called her a bunch of times already to get the upper G.I. test going and because I wanted to see if I could get a surgery date. She said that I can't get a surgery date and I couldn't get in to even see the surgeon until mid-March for a consulation, which bums me out because that means another two weeks of stomach pain. I asked if I could be put on a cancellation list, and she said, "Oh, no. We don't do that. Otherwise, we would be on the phone all day long." I wanted to say, "Uh, isn't it your job to be on the phone all day?" I guess they aren't worried about clients leaving and going elsewhere.

Anyway, I'll keep this thread updated on my progress. I am jealous of you, The Bionic Broad, and wish it could happen that quick for me too. I think you were really lucky to get such quick attention. Hmmm, how far is Harbor City from Ventura? LOL!

[CamarilloCA 41]

Camarillo,

Kaiser SoCal did my band to sleeve revision on December 13th. I was a self-pay for the band, and was in the same situation as you with the constant vomiting. I had a slight slip, but no erosion. Even with the scar tissue from the band, I had the band removed and revision done in the same procedure.

Hi Bionicbroad, I was just referred to the Harbor City Kaiser Facility. The bariatric nurse said that I would probably see Dr. Zane or Dr. Belzberg. My stomach still hurts so I am hoping that I can have the lap band to sleeve revision surgery fast like you did. I had the band unfilled so I am not throwing up anymore, but I still feel pain. My primary care physican said that the Upper G.I. report showed that I had a slight slip also. Can you tell me which facility or hospital you had surgery at? Woodland Hills is closest to me, but I'm sure they have one hospital they use there at Harbor City, or maybe Harbor City is a hospital? Thanks. At this point, I really don't care where I go or what surgeon I use. I just want to get this lap band out of me.

[thebionicbroad 127]

My surgery was done by Dr. Mun at Harbor City. Great facility. I have my 13-week check-up next week. I've heard good things about Dr. Zane, too. The other doc, I don't know about. Glad for your good news!

[CamarilloCA 41]

Thanks very much for the support:-) I will keep this thread updated. Maybe I will get Dr. Mun too. I am just hoping that I don't have to wait too long for an appointment. The girl that I talked to on Friday wouldn't give me an appointment time until my referral arrived there. She said that appointments are now being made at the end of March and beginning of April. Maybe I can be put on a cancellation list. It's hard to be patient when one's stomach hurts all the time!