Kaiser Questions

[Dymeond 19]

Yes, I have Kaiser of Colorado and their plan only covers 50%. What's really frustrating is that I used their estimator which states it uses my plan information to estimate, which I why I started the process. And then they turn around and say 50%. is all they cover and the entire bill is $28,000; so my share would be $14,000, and that's just for the surgery. I still have deductibles for speciality appointments with the doctor, mental health and the classes leading up to the surgery.

It just seems crazy...and I just need to research and see if there is something I am missing.

Thank God I found this post! I am in the exact same boat as you. I am also with Kaiser Colorado with a 50% benefit for bariatric. It is refreshing to hear you were quoted the same amount as me for Saint Joseph's, including the deposit amount. This issue also came up with another girl in Colorado but her plan pays less and they told her she has to pay almost $7k before the surgery which is absolutely ridiculous. Part of my issue is that I am starting the six week classes on October 27th and I have been on this journey for almost a year because I had to lower my bmi by 10%. Therefore I am completely invested with Kaiser and do like my services with them. My open enrollment is coming up in Nov and I may have to switch to Aetna which has an out of pocket max of $3k because they consider the surgery medically necessary when approved. The issue with Kaiser is bariatric pays completely different than other inpatient stays. I would normally have a 10% copayment up to $1500 OOP max. Bariatric coverage states the OOP max does not apply. I read somewhere on here that if you have to have another procedure such as a hernia repair that this benefit would kick in first for facility and anesthesia so you would only have to the additional cost for the surgery only which is only around $1500 for kaisers contracted price at 50%. I am tempted to see if I need a hernia repair just to test this theory. I asked both Kaiser and st Joe about financing and was told they consider the procedure elective so they likely would not offer this benefit for the surgery but I Still plan to try. I too was mislead by the online estimator and was told 1500 max OOP. I called into the regular benefits center before i even started and they confirmed this amount so imagine my surprise when I recently received this new figure from the counselor. I am looking into every option I can before open enrollment ends on Nov 15. I plan to call today to see is self pay would be cheaper and to ask if Kaiser if I can switch to the Colorado Springs area which is probably cheaper. Anyhow I will let you know if anything changes.

[shedo82773 1,236]

You know I forgot what we did for part of the money when hubby went to Mexico for his WLS. My KIA SOUL had been paid off for quite some time, so we took out a $6,000 loan and used my KIA as collateral. So it might be something to think about.

[Chrysaia 6]

Yes, I have Kaiser of Colorado and their plan only covers 50%. What's really frustrating is that I used their estimator which states it uses my plan information to estimate, which I why I started the process. And then they turn around and say 50%. is all they cover and the entire bill is $28,000; so my share would be $14,000, and that's just for the surgery. I still have deductibles for speciality appointments with the doctor, mental health and the classes leading up to the surgery.

It just seems crazy...and I just need to research and see if there is something I am missing.

Thank God I found this post! I am in the exact same boat as you. I am also with Kaiser Colorado with a 50% benefit for bariatric. It is refreshing to hear you were quoted the same amount as me for Saint Joseph's, including the deposit amount. This issue also came up with another girl in Colorado but her plan pays less and they told her she has to pay almost $7k before the surgery which is absolutely ridiculous. Part of my issue is that I am starting the six week classes on October 27th and I have been on this journey for almost a year because I had to lower my bmi by 10%. Therefore I am completely invested with Kaiser and do like my services with them. My open enrollment is coming up in Nov and I may have to switch to Aetna which has an out of pocket max of $3k because they consider the surgery medically necessary when approved. The issue with Kaiser is bariatric pays completely different than other inpatient stays. I would normally have a 10% copayment up to $1500 OOP max. Bariatric coverage states the OOP max does not apply. I read somewhere on here that if you have to have another procedure such as a hernia repair that this benefit would kick in first for facility and anesthesia so you would only have to the additional cost for the surgery only which is only around $1500 for kaisers contracted price at 50%. I am tempted to see if I need a hernia repair just to test this theory. I asked both Kaiser and st Joe about financing and was told they consider the procedure elective so they likely would not offer this benefit for the surgery but I Still plan to try. I too was mislead by the online estimator and was told 1500 max OOP. I called into the regular benefits center before i even started and they confirmed this amount so imagine my surprise when I recently received this new figure from the counselor. I am looking into every option I can before open enrollment ends on Nov 15. I plan to call today to see is self pay would be cheaper and to ask if Kaiser if I can switch to the Colorado Springs area which is probably cheaper. Anyhow I will let you know if anything changes.

I am so glad you replied. I am just at such a loss and the finance counselors at Kaiser just keep saying "Yes, we've heard this problem before and we're working on it." I just don't understand how Kaiser thinks. I'm at a BMI over 50, this isn't just so I can look pretty. This is to avoid serious health risks by continuing to carry around all this weight. Weight I gathered over time but continue to yo-yo on and off again. Even with watching what I eat and exercising as much as I can, I just keep bouncing between 320 and 255. This isn't elective, and I don't understand how they can continue on saying that it is.

I may have to look outside my employer medical. They only offer Kaiser or United Healthcare. Unless United Healthcare offers better coverage, I may have to go back to the drawing board.

I wish you the best of luck! No matter what you do, I'll be cheering you on =D

[shedo82773 1,236]

My hubby has United HealthCare thru ARRP and they covered WLS. Good Luck

[Dymeond 19]

Avarine--- Yes it really sucks. I am starting to come to terms with switching over to Aetna since paying the $338 for 18 mths is simply too much on top of all the other costs. I am still going through with the Kaiser process since it will meet the Aetna requirements. Potential setbacks are that the surgeon could require additional tests which Kaiser does not require any test. Definitely keep me posted!

[Hannah Lee 3]

Sorry to hear that Avarine. I have Kaiser in the Northwest (Oregon/Washington), I actually work for them, but here in our region, it is covered. I just had my $5 copays for office visits. I wish you luck in figuring this out! You will find a way, don't give up!

[Dymeond 19]

Ok here is an update. As is of 2017 all Kaiser Colorado plans now have a state requirement that bariatric surgery deemed as medically necessary must apply to the deductible and out of pocket max. Therefore you oop Max is the most you will pay. I called them yesterday and they confirmed this. So $1500 will be my max. Hopefully this helps you Avarine since the $14k is no longer an issue for us.