Kaiser Insurance anyone?

babycow · November 2, 2008

My Dr at Kaiser says my BMI is not high enough for the LapBand. However according to this site it is. My Dr insists this is not the right approach for me and stated that my BMI has to be 50 for my insurance to cover it. What do I do now? How do I get them to see my side and agree this is the right choice even though my BMI is not 50?. Thank you.

momcof3 · November 3, 2008

I assume you are talking about your primary care physician when you say your doctor. I know someone who had the same issue, but her BMI was 38. She contacted Kaiser Fremont directly and spoke to them and they accepted her. My PCP doesn't really believe in bariatric surgery, but I sent him an e-mail requesting he send a referral over for me and my BMI was 42 and he did. If your PCP is not cooperative, you could try switching PCPs. I don't know why they have to make it so difficult to get referred. I had my surgery at Kaiser Richmond.

Vicki J · November 3, 2008

First call patient services and get the bariactric number. Call them and ask them what the requirements are. From what I've read on this board, So. Cal requires the 50 BMI thing. If you have co-morbidities, that may be different. Many doctors (PCP) are not comfortable with WLS. You may have to go to another PCP. Also, you can appeal the decision. However, if you appeal, find out how many appeals you get. You do not want to blow them all trying by yourself. You can go to obesitylaw.com and they will help you appeal.