Kaiser So Calif - What's the process to get approved?

[KLG 0]

I am just starting to look at having the lapband surgery and have Kaiser insurance. Can someone tell me what the process is to have it approved by Kaiser? I'll just pay for it myself if it's too lengthy but thought maybe there are some shortcuts you might be able to tell me about.

[Savedbygrace 11]

I looked at their website to see if I could find their medical policy - which usually tells you what you must do to be approved. Bad news is I couldn't find that but good news is that they have a brochure on there about WLS so that's a sign they DO cover it. Call and ask them what you need to do. Good luck!!

[juliegeraci 7]

My friend is getting banded up here in Northern CA. They had her go to her Physician who put the request in for her to join the Bariatrivc treatment for lapband. They followed up with a full day seminar. She is going to have to meet with a psychiatrist and nutritionist. She has already had her blood work and her EKG. Here is the clincher. They are making her and everyone else wait 32 weeks for a follow up appointment. During this time she is to follow a 1200 calorie diet. If at 32 weeks she has lost a considerable amount of weight they will band her. They said that for some it is 10% for other less or more. It depends on where you carry your weight. She carries hers in her abdomen so they would want her to lose the most. The difficult part is she doesn't know how much she has to lose so she has to wait the 32 weeks to hopefully have lost enough. I am telling her she probably has to lose 30-40 lbs. She weight in at 270ish I believe. Her doctor is not happy that they are making her wait the 32 weeks as she is in a lot of pain with her back. The consensus is that they make you wait this amount of time to make you so discouraged that you will not have the surgery. So this is my exerperience with Kaiser. Let me know what happens.

[Vicki J 0]

I went through the No. Cal lapband process and it is quite frustrating. The main reason it's so frustrating is because they only do the surgery at 3 of the Kaiser facilities and are, therefore, quite overwhelmed. Their director of bariactrics is changing jobs so I don't know if the new person will get this straightened out or not. Yes, the process is long. The last time I was in the orientation room at S. San Francisco they were saying 4 to 6 months before the next appointments. I'm not surprised it's now 32 weeks. I think the availability of the band is causing a landslide of people to show up.

You also have to be the one to "keep in touch". When an appointment becomes available due to a cancellation, they don't call anyone to let them know. It sits there unless someone calls to check. So, my advice to anyone trying to get through the system "faster" would be to call and check for cancellations every week after orientation. Once you get through your appointments and are waiting for surgery I don't think you can do much else than wait. At that point they have a system in place to call and fill the cancellations.

I don't know how it is at the other facilities in Fremont and Richmond. This is just S. San Francisco. I was told when I went in and started the process in June '07 that you could not pick your facility. You were assigned a facility depending on where you lived.

At our facility they pretty much did the 10% thing. Yes, some people got away with less and some were required more. I lost 70 pounds of the 130 I want to loose prior to surgery. I made sure that they would not cancel my surgery due to too much weight being lost and then proceeded to loose. I figured that I was in this to loose weight anyway so why not start at orientation. That way they had my starting weight to show that I had over 40 BMI. I was banded in Dec. '07 and I'm now down 95 lbs.

So don't look at this time as wasted time but look at it as an opportunity to get ahead in loosing weight.

[Reece 0]

Has anyone went through the process here in Georgia? I went to a diabetes EXPO and found out about the lap band. Now I would like to start the process of obtaining this procedure.

[BroomHilda 0]

:tongue2:Hello Hello I am currently going through the process of Kaiser requirements in Southern Cali. First off you need to get a referral from your PCP to the baraitric dept/ preventive medicine branch.

Next you attend their orientation where they discuss all Kaiser's porgrams, Optifast, Fastslim and Options Classes. Kaiser requires all WLS candidates to complete a 24 week 6 mth mandatory course called the Options program and there is no way around it. I am friends with a lady who is in the process of appealing this requirement based on the fact that she is a previous WLS patient in need of a revision (NOT LAPBAND) however she has been waiting for over 3months. :embaressed_smile:

So good luck personally the classes were a pain but I think a rewarding one. I learned a lot about my inner demons, triggers and nutrition:crying:. During the course you are required to keep weekly food records and be weighed each week with the proposed goal of loosing 10% of your starting weight by the end of your classes and prior to surgery.

After and only after you successfully complete all 24 weeks you are instructed to have a ton of lab work done. Once your lab work is complete then you will be reffered to a surgeon to be evaluated for a lap band and/or gastric bypass. Kaiser does all lap bands in house but does refer out to preselected surgeons for RNY: Pacific Bariatric & Crown Bariatric (FOR BYPASS ONLY)

:angry:Just a heads up Kaiser is so anti lap band they are heavy pushers of the RNY gastric bypass. If you can make it through the 6mths of brain washing then you get to be where I am days away from my consultation appointment to be evaluated for a lap band. I am truly crawling out of my skin waiting for March 24th.

I hope this helps. feel free to PM for more details

Take Care,

Jessica

[BroomHilda 0]

Vicki J I am a Kaiser gal too about to go to my consultation appointment I would love to ask you questions about your process. Please PM me or post.

Take Care,

Jessica

[krismomma 0]

I was hoping to get some kind of info about Kaiser's policies about the lap band. I only know of Kaiser's policies on bypass, nothing on lap band. I was wondering if they give you a choice when they have you in that class they make you take? If anyone can give me some insight that would be great.:cry_smile:

[iluvlongnecks 0]

I am being banded through Kaiser in SF on Monday. They did ask me what my choice was for surgery and I went into this wanting the Lap Band. It's a long process to get all your appointments, but if you want it bad enough you do what is required. I have a wonderful, supportive husband that has driven me from Sacramento to South SF for each and all of my appointments....and believe me there was a lot of appointments. I am now finally having my surgery on Monday and am ready to get started on my journey to being a thinner me.

Kaiser is pretty strict, but I kinda liked that because they sent a message that it's a life time change and you need to be mentally ready to follow their guide lines.

I researched about the Lap Band for almost a year and loved it when I found this site as they can answer alot of your questions that you may have. Just reading what others have posted is very informative.

Good luck in getting started if you decide to do so. I'm hoping I have no regrets in my decision in becomeing a bandster, but I don't think I will, this forum has convinced me of that.

Edited April 19, 2008 by iluvlongnecks
spelling

[BroomHilda 0]

Yes, there is always a choice. As you go through the program all you will hear about is Gastric Bypass because that is the favorite and considered the gold standard. However when you elect to see a kasier surgeon it is there he will discuss all the different wls options including VSG, Gastric Bypass RnY, DS and Adjustable Gastric Banding Lap Band.

Take Care,

Jessica

[twty 0]

:thumbup:Hi, I getting banded at kasier in So Francisco 04/28/08. I started the process 09/18/07. I only had to wait 16 weeks and loose 20lbs. I lost only 151bs. Only six months to get a band date.

Edited April 20, 2008 by twty

[REEIZBOOJE 0]

I left Kaiser plan 3 years ago to go through Pacific Care (who covered 100% with Cedar Sinai to have my band. It was covered with them if my Pcp recommended it. I had to do the classes, and meet with the Nutritionist then I was able to have my band in about 6 months, but the whole insurance switch was a nightmare for everyone else in my family. I switched back to Kaiser now, and I'm wondering if they will do my fills, or do I have to go through a long drawn out process.

[twty 0]

HI Reeizbooje,

I'm thinking you would just pay for an office visit for your fill. The surgery is already done.

[presidenta13 0]

I'm in Los Angeles. I scheduled an appointment with my dr. and after some discussion, she agreed to initiate the process for me to get lap band surgery. She said I am the first patient she has gone through the process with. The first step is to attend a Bariatric Weight Loss class. Your dr. has to refer you to get into one of those. They called me on Monday and gave me an appointment more than a month from now. I just received a packet in the mail explaining more about the procedure. All the information refers to gastric bypass, so now I'm unsure as to whether or not they will even cover lap band. Again, the dr. was pretty uninformed about Kaiser's policy/process on lap band. The packet also says you have to attend 24 classes, once a week. That's 6 months! Plus assume that there may be some weeks where you have to miss a class. Any missed classes have to be made up. I'm really hoping that's only for people getting gastric bypass - not lap band. I'm really running out of patience. I've been on Weight Watchers for 8 months. I lost 30lbs. in the first 3 months and have been yo yo-ing between -25 and -30 lbs. for the last 5 months. And to further complicate things, I'm staying at a job that I don't really enjoy just so I can get this surgery covered. If I leave my job, I could get UCLA insurance (i'm a student there) but it's not free like the coverage I get through work. So I'm really eager to go to this weight loss class next month. If I find out Kaiser won't cover it, I'll leave my job and start this process through UCLA insurance.

[Orion 0]

About 6 years ago I looked into bariatric surgery through Kaiser but was totally frustrated. At the time they only did RGY and the doctor in charge of the program declared "I have no idea how European doctors canreport success with lapbands because I don't see how this could possibliy work." They also lost appointments, it was hell to reschedule, and it all came to a head one day when some little bunny in a white labcoat told me I had to lose 35 pounds firsr or I was wasting my time. I dropped out of the program after that remark.

I stopped using Kaiser after that and don't know if they've improved or not. I'm surprised they finally started doing lapbands. I guess they realized they could make money at it.