Anyone with Kaiser Northern Calif with Covered California?

[kmn1109 4]

After having hit a brick wall with Blue Shield (if your Blue Shield coverage is through covered california, you are limited to doctors/facilities in Southern California, and the closest one for me is 6 hrs away), I am considering switching to Kaiser during the upcoming open enrollment. If you've had the procedure approved and you're with Kaiser Northern Calif, would you recommend them? Are their requirements so strict that a lot of people get declined? I had read somewhere that they require that you've been morbidly obese for at least 2 of the last 5 years. Is there somewhere I can find a list of the co-morbidities they consider? I have high cholesterol, fatty liver and stage 4 osteoarthritis and am right at 40 BMI, but they say that they will consider 35-39.9 BMIs if they have serious obesity-related health issues "such as diabetes, coronary heart disease or severe sleep apnea." So I feel like I need to gain a couple of lbs. (which I'm good at) to have a little cushion. I can't get info on the Kaiser website unless I am a member. Bottom line is, I don't want to switch to Kaiser only to discover that something will disqualify me. I see some specialists I'd prefer not to give up, so would hate to be stuck with Kaiser if I can't get approved for the surgery through them (or they don't cover it if you get it through covered california. )

Has anyone here with covered california navigated this maze?

[Ed_NW 684]

I have Kaiser in Washington State. I had to change Kaiser plans to one that will cover WLS. Most likely you will have to call a representative at Kaiser in northern CA and ask which plan covers it. I had to have a couple of conditions related to obesity. sleep apnea is one it seems they automatically diagnose anyone that is 5 lbs over weight with. I take a small dose of BP medication. Oh, another one like sleep apnea that they really can't disprove is acid reflux. Get a doctor to prescribe some acid reflux meds. I only had the sleep apnea and high blood pressure diagnosis along with my BMI over 40 and it was approved. There's other comorbidities like diabetes and it might be different in every case as far as insurance acceptance but hopefully this will give you an idea of what to expect. Good luck!

[karenn 2]

Thanks for taking the time to respond. I've never had blood pressure problems, but if they were to slap a cuff on while I was talking to the know-nothing insurance people, it would be plenty high enough to qualify! But seriously, good to know the ins and outs of sleep apnea and acid reflux After looking through the symptoms for each, it looks like I could have both. I'll talk to my PCP at my next appointment and get a scrip for an acid reflux med. and a cpap mask.

[baribetty 165]

I agree, call and chat with a membership rep about the plans that cover it. I used Kaiser in So cal, but my mom had a Kaiser surgeon do her sleeve surgery years ago in SF. Honestly, both of us have had incredible experiences and great care.

[kmn1109 4]

Good to know, thanks!