Who should I go to first?

[PammyC 0]

Hello everyone, I'm new here! I haven't started the process of pursuing the lap band, but I would like to as soon as possible. I have insurance through Kaiser Permanente. Assuming that they do cover the procedure, which I think they will considering my mom is a nurse and I have amazing insurance, where do I turn to?

Should I bring up the topic with my doctor, or should I go to a surgeon for a consultation. And also, what doctors would yall recommend. I'm in southern california in the Los Angeles and Orange County area.

I guess that is my question for now. Just how to take the first step. Any suggestions would be greatly appreciated!

[RestlessMonkey 7]

Find out if the insurance covers it, then follow their directions. Some must be referred, some don't require that, etc etc. I had to pick from surgeons my insurance would cover and once I had done that, had to attend a seminar given by the surgeon of my choice. Once done there, I made an appt to see him and then he directed me for specialists/tests etc as required. I went to my PCP but didn't need to...no referral was required by my insurance. So you have to see what coverage you have, and then what prereqs it may require of you.

[riley4183 0]

Hi Pammy!

Kaiser does indeed cover the Lapband if you meet the criteria (BMI 40 or over, and pattern of unsuccesful attempts to lose weight and keep it off) (or BMI over 35 and 2 co-morbidities). They have their own surgeons and each center that does the surgery has their own rules. I started the process by emailing my PCP and telling him that I had been doing a lot of research and this is what I wanted, he emailed me back to make an appointment and come see him, meantwhile I signed up for the Healthy Lifestyle classes, when I went in a couple of days later my BMI was well over 40, my blood pressure was uncontrolled enough for him to put me on a second medication, he saw that I was in the class and he sent a referral over for me. BUT. I understand from my Kaiser support group that each bariatric center is different, and that some may still want you to complete classes before they will accept you into the program. In Reseda for example you need a 6-month class to be referred for orientation. There is a program in Harbor City and they are just starting one in West LA, I don't know where the other SoCal ones are. Most Kaiser paitents have to drive an hour or more to the surgery centers I think. I know I do! Go to kp.org and search by the facility . . . . for my program (Richmond), the is a whole information binder available online that tells EVERYthing about the steps in the process. Good luck! :tongue2:

Riley

[RestlessMonkey 7]

Just a caveat...I don't know a THING about insurance in California! But unless an insurance is "nationalized" (ie tricare, medicare) then the purchaser (usually an employer) can pick and choose certain things (like different deductibles, different pay out "life time" limits, etc) and one of the things urchasers/employers can (and often DO) exclude is bariatric surgery. So unless Kaiser (or Calif law) is very different, just because one person has Kaiser and gets lap band surgery covered, doesn't mean another, with a different employer, policy and deductible, will have the same benefits. I hope it covers it and it sounds good so far, but check to make sure what YOUR policy provides!

[riley4183 0]

True, true! Do check and see! While Kaiser IS very different (it's an HMO, so you can only go to their facilities but as long as you do you're covered), Monkey is very right about what it might cost you, co-pays, deductables and so on. All the plans are different, and the individual plans are different-er yet. I have the highest level of Kaiser coverage, and I still have a co-pay as of the beginning of the year - and I never did before. So do check! In my class the out-of-pocket costs for bariatric surgery - all at Kaiser Richmond of South San Francisco - range from $10 to a couple of thousand.

Check it out!:tongue2:

Riley

[JayTee562 1]

My insurance at the time required PCP referal. I'm glad I started wiht him even though he doesn't seem to know a lot about the requirements. He has refered me to a great surgon who's staff is being very helpful.

[LvnDreamz 0]

Just a suggestion...

Make sure your surgeon works closely with your PCP. Some insurance companies will only pay standard coverage when tests, etc are ordered by primary care.

I got a little tripped up when my surgeon ordered tests and my insurance covered them at a different rate than ones ordered by my PCP.

Also, make sure your surgeon provides you with a list of procedures that he requires and then run that by your health care advocate/insurance company and PCP. He can order them and then fax results to surgeon.

Fo example, many people at my former employer had lap bands and one of my coworker's wife worked in the surgeons office and was tremendously helpful. I was one of the first that she assisted that needed an UGI before the surgen approved me for surgery. The surgeon requested this due to my age (49), and my history of smoking.