Advice on how to proceed with Kaiser?

[astone1234 0]

I have a question that I'm hoping someone can advise me on... I'm 5'7" and in February 08 after being on phentermine to try to shed a few pounds I had a bmi of 38.7. My PCP recommended a sleep apnea test & the results came back as "mild" so my Dr. sent a referral to Kaiser's Bariatric Dept. Because the apnea was only mild and the bmi was not 40 at the time with no other co-morbidites, I was denied acceptance to the program in April 08. I stopped taking the phentermine because I didn't like how it made me feel and I have gained back all that I lost plus a couple. I believe I'm now back at 40bmi which should allow me to now qualify.

Should I ask for the referral to be resubmitted now? My PCP is supportive and is happy to do it but I am nervous that Bariatrics will deny me because 4 months ago my bmi was too low. Will I qualify no questions asked since my bmi is at 40 or will I run into trouble?

Has anyone had the experience of being denied by Kaiser & then put on the weight and been accepted?

Any advice?

Thanks!

[lizzy h 0]

1st out of curosity where area of the country are you in?

I am a life long - since birth 43 years ago today Kaiser patient. My rants are about their lack of understanding of bariatrics....that said I was referred to the program in approx March 2003..... after doing a handful of support meetings and the nutrition counseling and phsyc eval I was denied - approx Sept 04. For open enrollment in Oct of that same year I added a second carrier and when it was effective on Jan 1 04 I went outside the Kaiser family and to a different surgeon.....3 months later Kaiser sent me a letter saying they had reconsidered and I was green lighted. It would have taken me 9 months, at best, from that date to have been given a surgery date, so I stayed with the private doc - best and right decision.....mind you I never appealed their denial, this letter came out of the blue. I am back working my way through the Kaiser system to get the right fit for my fills and it is worse then ever. I personally think Kaiser is great for everything except bariatrics and phsyc...Tell me what region you are in and I may have some pointers

[astone1234 0]

I am in Northern California. I was denied by Fremont. Thanks so much!

[lizzy h 0]

ok my understanding is that it is only done in Nor Cal in Fresno, SSF and one east bay location (either Richmond, Hayward or Fremont)...I am assuming that you have not yet done the psych eval, or the nutritionist apt. So get an appt with your PCP again.....xplain that you need the help (they are really hot on the term "tool") and that the diet pills have side effects that are not workable......dry mouth, shakey-jitterly, and more trouble sleeping...... when was the last time you did blood work, esp the sugar diabetic test.....if you have ANY family history of diabetes bring that info with you as well.....ask for a referaal to SSF if you can get it - or a referral back to your local hosp......call the bariatric group at your local hosp and ask the receptionist if there is a usual shrink, or social worker that does the evals.... have your PCP ask for that apt referral too.......find out when the preop support mtgs are....GO TO THEM...BE SEEN....PARTICIPATE......Make friends (suck up) to the moderators - you may end up needing them to help you with your appeal...start with that and basically do nlot take no for an answer - but ALWAYS KILL EM WITH KINDNESS

[beagoodgirl 0]

Hi there,

My name is Brenda and I am just starting the process of trying to get approval for surgery through Kaiser. My friend was denied because of a BMI below 40 but when it was over 40 a few months later - she reapplied and received approval.

I am wondering who your PCP is if you don't mind me asking and also which kaiser you were referred by?

Good luck with everything - we might just be beginning our journey together.

[astone1234 0]

Hi Brenda! My PCP is Dr. Sumaquial in Pleasanton. She is very supportive and just resubmitted my referral for me. I'm nervous because I have the required bmi now but I'm afraid that they will deny me based on my lower bmi 5 months ago. Your note was encouraging that your friend got accepted with similar circumstances. Was that through Richmond? I'm hoping for the same result!

Pleasanton Kaiser automatically refers to Richmond Bariatrics. When my PCP sent the 1st referral to Richmond, I called Richmond & asked if I could have it forwarded to Fremont as it is much closer for me. They agreed so my denial letter actually came from the Fremont office. I thought the second referral would go on to Richmond but my PCP said she sent it to Fremont. Yikes, I was kinda hoping for Richmond the second time around because they hadn't been the ones that denied me, but we'll see what happens. I have total anxiety about the whole deal!

I have 1 friend who was banded in December 07 and loves it (not thru Kaiser) and I have 2 friends who are going thru the process w/Kaiser Richmond right now. 1 has a surgery date of 7/8/08! I can't wait to find out all the scoop on the procedure.

One of my friends, who is thin btw, was trying to be supportive & had some stinging words for me... She said "you are a professional dieter. You've done this all your life. Just think how nice it will be to actually do it & succeed for a change". Ouch!

The truth is that I AM tired of failing all the time. I AM tired of being "queen of the yo-yo dieters". It will be great to have the band as my ally & finally succeed at this life-time battle. I realized at the moment she said those words that I have to have this done. I don't want to be that person any more.

Please feel free to email me anytime. I'd love to help support you in any way I can.

[beagoodgirl 0]

Check this link out....it is the Kaiser - Fremont criteria sheet for referrals through the entire process. They cannot just randomly decide who and why to deny. If you meet the criteria (ie: BMI 40+) - you get the referral and the process begins.

Take a look.....Physician Management of Bariatric Patients The Kaiser Fremont Bariatric Program

I have decided to do the gastric bypass and not the band... and I hope all goes well through the process. My first doctor's visit is the 9th and I've signed up for the orientation and the lifestyles class. My "official" weigh in will be on the 9th and I can start losing the 10%....

I am sure you will be fine - lets keep in touch since we are so close - it is nice to have someone to share the ups and downs with.

[juliegeraci 7]

Good luck with Kaiser. You poor girls sure have to jump through hoops to be banded. My closest friend is working to get banded in SF. I am going with her in July to meet with the counselor. she has not lost her 10% yet so I am working on that to help her.

[beagoodgirl 0]

It's nice to have a friend to go through the hoops with. I have a great best friend who is totally supportive as you are to your friend. She motivates me and I am sure going to need it as the process becomes more daunting...

I wish your friend well and congrats on your success.....

[astone1234 0]

Brenda, is your orientation at Fremont, SSF or Richmond? How long did it take between PCP referral & the notification from the Bariatric dept that you were accepted and received the 1st orientation meeting date?

[beagoodgirl 0]

Hi there,

My orientation is for the healthy living class...not for bariatrics yet...I am trying to get ahead of the game - as most people who attend the orientation and begin the healthy ways class and the seminar on WLS seem to have better luck than those who dont. I guess it is showing initiative and commitment.

I will let you know the timing as I go. My PCP appointment is on the 9th and I am just going to tell her I want the surgery and have her do the referral right there in the office on the 9th. It is supposed to be standard procedure if you meet the BMI criteria.

I am hoping it goes smooth.....

[ReeRee 0]

I was banded a Kaiser SSF on the 23rd.

My BMI was 39 but both generations before me had heart attacks and I also had joint pain. I lost the 15# they required me to lose. I went to every class and appointment and did exactly what they told me to do. My surgery went well and everyone at the SSF facility was terrific! I commuted from Sacramento - I don't care how high gasoline got - it was completely worth it.

[beagoodgirl 0]

How long did it take from the referral from your PCP to surgery?

It is so nice to here success stories....I am so excited and anxious and just hope all goes well.

[astone1234 0]

I just received my acceptance packet from Kaiser! I can't believe it... my orientation class is 7/27 in Fremont! I am so excited that the process is officially on it's way!:thumbup:

[beagoodgirl 0]

that is just great news.....

Question....did your PCP make the nutrition / psychiatric evaluation appointments and then you got the packet? I have told my PCP I want to do it...she agreed and has set up all the lab work (which is done) and now the nutritionist and then the psychiatrist appts....(scheduled already).

Is this how you proceeded?

Thanks and again, congrats - it is a huge deal isn't it!!!!!