Kaiser Southern California Pays for Lap Band

[missbossyboss 0]

After spending a considerable amount of time searching for information regarding Kaiser Southern California and Lap Band surgery. I sent an email to my PCP (via www.kp.org) and to Member Services. My PCP's nurse referred me to the Positive Choice department and today I received the following detailed information from Member Services:

"Members who meet the medical criteria and are interested in having bariatric surgery enroll in 'Options', a 24-week bariatric surgery preparation program that prepares them physically and emotionally for surgery and for post surgical recovery. There are complex medical and emotional effects of gastric bypass as a treatment for obesity. Our total health philosophy emphasizes members taking an active part in their own good health. Topics covered in the Options program include :

Benefits and risks of surgery

Building healthy living skills

Depression and anxiety management

Fitness and exercise

Meal planning

Post surgery lifestyles

Proper nutrition

Stress management

Weight loss

After completing the Options program, the member is referred to a surgeon specializing in bariatric surgery.

Conditions for surgery

Bariatric surgery may be indicated for members with a body mass index (BMI) of 50 or greater, BMI of 40-49.9 with certain co morbidities, or BMI of 35-39.9 with special circumstances. BMI is calculated by dividing weight in kilograms by height in meters squared (kg/m2).

Types of surgery and procedures offered

We perform Roux-en-Y gastric bypass (RYDGB) surgery, the most commonly performed type of gastric bypass surgery. Gastric bypass is the separation of a small section of the stomach into an upper pouch that provides a smaller volume for food. The small intestine is rearranged to allow the small upper pouch as well as the larger section of the stomach to be connected to the intestine.

The Lap Band also know as the adjustable gastric banding is the insertion of an inflatable silicone device into the top portion of the stomach to create a small pouch that provides a reduced volume for food and slows food moving to the bottom of the stomach, providing a longer feeling of fullness.

Medical facilities offering the Options program

Members enrolled in Options may attend at any medical facilities where it is offered. These currently include :

Baldwin Park Medical Center

Bellflower Medical Center

Fontana Medical Center

Health Pavilion in Orange

Los Angeles Medical Center

Ming Avenue Medical Offices, Bakersfield

Panorama City Medical Center

Riverside Medical Center

San Diego Medical Center / Kaiser Foundation Hospital

South Bay Medical Center in Harbor City

Bariatric surgery

Bariatric surgery is currently performed at the Kaiser Permanente South Bay Medical Center in Harbor City, CA. We also contract with local Centers of Excellence :

UCLA Medical Center, Los Angeles

Pacific Bariatric Surgical Medical Group, practicing at Scripps Mercy Hospital, San Diego

Crown Surgery Medical Group, practicing at the Inland Valley Medical Center, Wildomar

Lancaster Community Hospital, Lancaster

If this surgery is performed your co pay would be $250.00 per admission.

Kaiser Permanente : Helping our members live long and thrive.

Marteesha Facen

Member Service Online Web site Support Representative

Kaiser Permanente

Phone : (800) 464-4000"

I hope this information is helpful.

[wlsnull 0]

Thanks for the info, I just decided to do lap band last week and have been looking everywhere for the info. I live in south Orange County and have a PCP appt on Thursday. 50 BMI minimum is high, most insurance companies benchmark wtih 50. I'm in the 40s and don't have any comorbidities, hope I can convince the doctor I need the procedure.

There's another program I'd rather do, but I'll have to go where it makes financial sense (unfortunately!).

[ahmamama 0]

Thanks for the information. I have been trying to get the information for insurance. This is very helpful!

[OneHotMama 0]

A BMI of 50 is crazy. Most other insurances as well as Kaiser NorCal is only 40 according to others on this board. As a Kaiser SoCal member who "only" had a BMI of 38, I had to self pay. "Healthy" fat people get screwed! Thanks for letting me rant! Any idea what they charge for fills? Regular office co-pay? I wonder if I could go to them for fills even though they didn't band me.

[wlsnull 0]

Okay, I didn't ask about lap band because I've switched to Gatric Bypass, but I finally tracked down the Orange County person. Her name is Janet and her phone number is 714.748.2798.

She says that it used to be 50, but the program is a lot more flexible now and will do it for 40. Mabe 50 is for the band and 40 is for bypass? Seems like it would be the other way aruond since the band is less invasive... It took me a looong time to find her, nobody knew where to direct me and one person didn't know what bariatrics was.

She said that in Orange County the 2 workshops are on May 14th and 18th (or at least that week) and that if you call the appointment center they will tell you the classes are full (which they told me). She can override that.

After that you can start the Options Program. The June program is full and bursting, but there are some spots left in July. It sounds like there's one group started each month, meetings are at the Pavillion in Orange (looks more like Anaheim Convention Center) at 6pm every week. (It would mean leaving work about 2 hours early to do the classes)

I'm not sure where everyone else is, but at least Janet may be able to get you to the right person in your area. (Hope I'm not making her job any worse by posting her #!!).

Good luck!

Edited April 14, 2009 by mburgs

[wlsnull 0]

A BMI of 50 is crazy. Most other insurances as well as Kaiser NorCal is only 40 according to others on this board. As a Kaiser SoCal member who "only" had a BMI of 38, I had to self pay. "Healthy" fat people get screwed! Thanks for letting me rant! Any idea what they charge for fills? Regular office co-pay? I wonder if I could go to them for fills even though they didn't band me.

Yeah it's crazy, I'm self paying too. It took 3 weeks to get to someone at Kaiser and in that time I've found an outside provider that I feel really comfortable with, had an info session, had all of my consults, and had most of my labwork done. I get the rest done on Thursday, see the internist for final approval next Monday, and I have surgery May 8th! Crazy, huh?

Going through Kaiser is tempting for me and I'm getting a lot of flack on other boards for financing the procedure, but I'm 25 and just really feel I cannot wait another 9 months for the procedure. I can have a drastically different lifestyle by my 26th birthday this way, with Kaiser I would just be going into surgery.

Where did you get your band through?

[Shalee04 7]

I'm curious to know if Kaiser So Cal will do fills even if we were banded elsewhere, or have since changed insurance and have Kaiser now.

[wlsnull 0]

that's definitely a good question! It's rough traveling so far from home for surgery, even if it's just an hour. there was one person, I think Kaiser that had flown out to Northern CA to get it done and had complications and was in a strange place without support for a long time. SCARY!

[OneHotMama 0]

mburgs - I ended up going to Mexico, Dr. Aceves. I was totally happy with the experience. Originally I said I would NEVER go down to MX but after being on these boards and seeing the potential complications(meaning more $) I better look at all my options. Up here it was going to cost me $17k, I already had financing hooked up and everything. Well, Dr. A was $7k for a he!! of a lot more service too! I have gone back for one fill, he does all his fills under flouro and the only cost is for the x-ray ($60).

[jennifermarie 0]

I have SCAL KP ... I have a bmi of 42 with high blood pressure that is well controlled with medication. When I finally tracked down my referral from my pcp, I was told that the next Options Program in Panorama City would begin in July. I mentioned the lap band to the person on the phone and was told that the doctor would decide what was best. Just to confirm, I asked if it would take about a year to have surgery. She quickly responded, 'oh no! it'll take at least 18 months and in some cases 2 years!!!'. Well, that was the deal breaker for me, on top of maybe fighting with a doctor for what procedure was best for me. I didn't tell her that though :scared2:

I decided to go elsewhere and self pay. Since that phone call, I have researched a number of doctors and facilities. I have settled on a surgeon, gone to his seminar and had my consultation. My surgery is scheduled for June 22 '09!!!! I still have not heard a peep from Kaiser.

I think many plans will either begin to make it harder get the surgery or stop covering it all together. I think the costs will outweigh the benefit in the long run. Because the assumption is that all fat people are expensive and that's not always true. I think plans will spend more on more skinny people who smoke over time than fat people. I think that's why it takes so long for some plans. They're trying to weed some of us out of the process.

A little secret... I also work for KP and there are HUGE differences between the North and South for many things that they do. It's almost as if the regions are different organizations. So when you hear that they do it one way in the North but not the South, don't be surprised.

[swrktp 1]

I went through Kaiser NorCal and had my surgery in 4 months........I had to lose about 35 pounds before I would qualify though..........most people take 6-8 months......

My BMI was 41..............no six month program but very strict diet and lots of hoops and appointments to jump through

[jennifermarie 0]

I went through Kaiser NorCal and had my surgery in 4 months........I had to lose about 35 pounds before I would qualify though..........most people take 6-8 months......

My BMI was 41..............no six month program but very strict diet and lots of hoops and appointments to jump through

Yeah, you NCAL'ers are lucky, but I have no regrets for doing it on my own. For all of us who have done it or plan to have it done, I have high hopes. I'm glad it's available, however we can get it :scared2:

[jennifermarie 0]

I went through Kaiser NorCal and had my surgery in 4 months........I had to lose about 35 pounds before I would qualify though..........most people take 6-8 months......

My BMI was 41..............no six month program but very strict diet and lots of hoops and appointments to jump through

Another thing is that in So Cal, wherever you look there are billboards, bus ads, and TV commercials for Lap Band. This added attention might have something to do with the time taking longer than the typical 12 months down here. I'm just guessing, because the ads might be just as big in No Cal, except that NCAL KP might have their act together better than SCAL. I don't know :scared2:

I'm just glad to be getting it done! Too excited to worry about anything else.

GOOD LUCK!!!!

[swrktp 1]

The ads and commercials are just starting.........no billboards yet. When I started in November no body knew about lap band, now in just four months it is going wild up here.

Things is Kaiser said only about 1/3 of people who start out make it through all the hoops and they have a really, really strict diet up here starting from day one..............you have to lose 10% of your body weight.

Also I live in Sacramento and had to drive to San Fransico two hours away for all my appointments.......that is where my fills will be too.

So I have had to and will have to take alot of time off work to make this work out........

[wlsnull 0]

Hey guys,

I went to the Kaiser Options program workshop and the Weight Management Workshop this week and last week. They were incredibly negative w/ the band - they said that they strongly suggest most people do gastric bypass. (Some of this could be b/c you have to have a fairly high BMI to qualify under Kaiser)

For fills you'd have to go back to the surgeons. There are 2 doctors in Orange County who oversee the program, but the surgeons do the fills.

I went to the PCP for the official referral into the Options program and then I meet with he coordinator Janet and then the doctor(s) in charge of the program.

Usually you have to wait until after meetin w/ the docs to get placed into an Options class so yes it can take a while to get through the process.