Kaiser disqualified me, now what?

[knbmom9699 0]

So I have a doctor at Kaiser that is so anti weight loss surgery. She says that my comorbids do not qualify (GERD & Depression). I cannot afford to pay out of pocket because I am so financially screwed right now. I am so bummed. I will continue on my yo yo dieting because it is so damn hard!!!!!!!!!! I feel like I just have to starve sometimes because I am always hungry or have cravings. Then I get bummed out because I can't have a piece of cake or ice cream with my family.

I am so lost and depressed. I thought I found something that would actually work and now I am knocked down again. Helllppp!!:huh2:

[TQUAD64 9]

I am not familar with Kaiser, but can you get a second opinion? Can you switch doctors? Find a Kaiser doctor who is more supportive of the procedure?

[heartfire 4]

First, get a new PCP.

Second, what is your weight and BMI?

Kaiser follows (at least Nor Cal) the national standards of a minimum BMI of 40 without co-morbids or a BMI of 35 with 2 recognized co-morbids. I qualified with the BMI alone. I'm not sure what ALL of the co-morbids are so can't help you there.

You do need your PCP's help b/c they have to refer you to the seminar, then to pysch and nutrition, then once that's all done, they have to send the referral to bariatric surgery. So, since that is the case and your PCP works for YOU, fire her and find another one!

This will cost you. I had minimal travel expenses- gas to the city once a week for classes, seminar fee, co-pay for every appt I had, including surgery and fills BUT it's much easier than trying to finance it yourself if you can get through the system.

Best wishes!

[momcof3 1]

Even with a BMI of 40, Kaiser wants to see that you have tried all the other avenues - ie Healthy Ways at Kaiser and other weight loss programs like Weight Watchers. There is also a Mindful Eating class at Kaiser (I took it at So. Sac) that is in adult psychiatry. My PCP at Elk Grove Kaiser is also not big on WLS, but I had already done Healthy Ways twice, the Mindful eating class, and Weight Watchers a few times. I don't have any co-morbidities - he sent me for the sleep apnea test a couple of years ago when Kaiser only did gastric bypass, but I didn't have it. You can switch PCPs at Kaiser to see if you can get one that is more open to WLS but I think they will all look for certain things in your history as far as attempts to lose the weight. Good Luck.

[AudsMom 2]

I just got a letter in the mail that now kaiser plans will not require a pcp referal so that should help.. its supposed to be for 2009.

[Vicki J 0]

First - As people have said before me, get a new PCP. You will want one after surgery so that you will have a better support system within Kaiser.

Second - You can always appeal. Yes, they do have an appeal process and you should be able to find out the particulars through patient services and bariactrics.

You did not say what your BMI was. Assuming it is over 35, I would also get records from any chiropractor you've gone to because joint pain is a comorbidity. I would get a sleep apnea test. I would also go online and find out what other items qualify for comorbidities. You can go to smartbandsters.com for that. Also, if you have any records from other doctors, diets, etc. gather them together.

Lastly, get ahold of obesitylaw.com if all of the above fail. They handle appeals and they will be able to tell you if you have a case or not. They only charge if you have a case and you hire them to represent you. I don't know the charge on that but they are evidentially very successful on the cases they represent.

You need to want this bad enough to fight for it. Getting depressed will not get you anywhere. I know because I wasted a whole year before I decided to get it together and fight. Fortunately, I changed PCPs first and the one I have now is a jewel. The first one I had said that even with a BMI of 46 (which she never even stopped to figure out) I wasn't heavy enough for Kaiser to cover me. Like I said, I wasted a whole year.

If your BMI is lower than 35, I don't think you have a good chance at getting the surgery. Unfortuately, they don't think of this as a necessary surgery but instead think of it as an elective surgery. I find this ironic because ALL surgery is elective if you think that way. They would justify this by saying that some surgeries are necessary to keep you from dieing. My response is "And you think this is not?"