Kaiser and skin removal/plastic surgery answers

[krysnik23 0]

I read a couple of posts from people who were told by Kaiser that skin removal and other post bariatric plastics are not part of their plan.

I don't want anyone to suffer for years as I did because of being told the wrong information! I'm learning to push back when told NO since often times the people on the other end of the phone tend to not have all the answers or are told to derail people with questions from learning the real truth in order to save $

Anyway, there was a class action in 2015 against Kaiser sparked by post WLS denials. And as it turns out this can have repercussions for insurance that systematically deems skin removal as an elective surgery that isn't covered in cases of extreme weight loss.

Link https://blog.cvn.com/kaiser-ordered-to-broaden-reconstructive-surgery-coverage-after-class-action-trial

https://legalnewsline.com/stories/510629463-calif-judge-rules-that-insurer-at-center-of-class-action-over-skin-removal-surgeries-must-broaden-coverage

When I went to be evaluated for plastic surgery in 2017, we were told we could have one procedure. Dr said I didn't qualify for a panni because it didn't quite hang low enough, just to clarify...their measurement is 'abdominal skin must cover pubic region entirely'' which is BS with the years of skin rashes I have had.

He said I just barely qualified for breast reduction surgery which I had 5 months later, the waiting list was long. He said I would be a C cup (from a DD) and I wasn't happy when I ended up a B but worse things could happen.

I'm 16 years Post Gastric BP and should've had a revision 4-5 years ago when weight gain started creeping up, no longer going down... about 15 lbs a year since 2018. I could never break past 170 to reach goal of 155 but I'm goin to pursue the distal revision as of this week. It's now or never, I have to get a social life! The rule is you have to be at your goal and stable for months before a skin removal surgery will be covered by insurance so I'll have to wait longer even longer for that as consequence of procrastinating on a revision!

I've been disabled with an autoimmune illness so I never returned to the job I enjoyed after the WLS. I didn't put much effort into pursuing solutions for skin removal after research showed it would be very costly out of pocket expense and not covered by insurance. So I haven't really felt the freedom of losing 140 lbs because I still cover up my body! No swimsuits, no sleeveless anything or clothing that accentuates the possibility of a waist, LOL. I wish I had the confidence of those who wear what they want, no matter their size!

I've wanted to leave Kaiser to return the awesome Dr I previously had who actually listened and treated me like a human being. Staying with Kaiser only until these surgeries are done and I'm out of there!

Kaiser ruling.pdf

Edited September 5, 2021 by krysnik23

[RickM 1,748]

Yep, Kaiser can be tough - which is how they keep their rates low(ish). They would never approve the DS, as they don't have the capability in house,, but they lost the appeals to the state so frequently that they finally contracted with our surgeon to do them for those who got through the gauntlet and the state forced them to cover it.

Just have to keep pushing with them, but many just give up (which is what they are counting on.)