Just referred!! Northern California Kaiser patient

[divanessa]

Hi everyone! I'm specifically looking for some Northern CA Kaiser pros to help me navigate through my WLS journey. I was just referred today and am actively seeking out the date and time for my options class. I'm 5'2", 240 lbs with a BMI of 44. I'm 29, in generally good health and have been reading a lot about the DS surgery. I live in Walnut Creek and am currently going through Park Shadelands. Anyone have any insight on how to become approved for the DS? What are my chances? Thanks so much! Xoxo

[smileyjamie]

I have no Kaiser insight, but I just wanted to say, WELCOME!!!!!!!!

[Gail R]

Hi, I'm your neighbor. I live off Pleasant Hill Rd. I was with Kaiser until last month and had my DS three years ago. There are a number of steps I had to take to get the DS. First I had to get into their bariatric program and not until then could I mention that I wanted the DS. At that time they were routinely denying it to everyone. I have heard that they do now give it to some. After I was denied, I filed a grievance with Kaiser. The grievance letter must be carefully written and crafted as it will be sent on to the California State insurance board. If you have to go this far, you will need to send a number of references and letters. There are others here (as well as myself) who can help you with this so stay in touch with us for help. The insurance board has a very good record for overruling Kaisers denials and you have an excellent chance of approval. It's really not as difficult as it sounds.

[mrss]

Gail! I had no idea, we are neighbors too! I'm in Concord near W.C & P. hill. I live off Mohr lane (near Bancroft)!

I had my DS through Kaiser (starting with a class at park shadelands) 6 months ago. I had help from WONDERFUL people here. I will be glad to help in any way I can, if only for local support!

[divanessa]

Thank you so much, Ladies!! Thanks, Jamie for the welcome!

I'm so glad I found this group;-) I really appreciate your support. I live off Treat and Oak, just across from PH Bart, so we're all neighbors! I'm set to call tomorrow and find an introductory class to attend. Then I suppose I'll be hitting the Iron Horse trail on the quest to lose my 10%. Can I ask, MrsS, how long the whole process took you, from start to finish? And did you have to go through what Gail did to get your DS? Thanks so much ;-) ~Vanessa

[larra]

Hi and welcome!

Diana is right about the 10%, sort of - Kaiser won't waive the requirement, but the DMHC will force them to waive it. People don't know this, unfortunately, and a lot of people miss out on much needed medical care because of it.

There are no "options" classes in NorCal. That's a SoCal Kaiser thing. There will be an orientation meeting or two, and perhaps some other educational session, but not months and months of classes.

Now, about the DS...you are going to get a denial. Get used to the idea that you will have to file appeals. They are only approving people with a bmi over 50, regardless of any other medical problem you may have. However, you can do what Gail did, which is to go through the appeals process, first through Kaiser's internal appeals, which will result in a final denial, and then to external appeal with the DMHC, where you stand a good chance of winning.

Keep the DS issue separate from the 10% weigh loss issue. And sadly, it's probably best not to lose any weight before your official weigh in - depending on what facility you are sent to, they may or may not count any weight loss you do before the official weigh in.

Lastly (for now) while it's best not to mention the DS til you get to your consultation with a surgeon (which is when you will get your denial), there is no reason you can't talk to other patients you meet at these orientations and classes along the way. There is no reason you can't refer them to this excellent website and to dsfacts.com to learn more about it. You will, eventually be helped through your appeals by people who ask nothing in return other than that you pay it forward.

Larra

[mrss]

divanessa- I was "lucky" in a way, as in that my starting BMI was over 50. Kaiser treats that a little differently, so unless this is the case for you, my process will be different than yours.
What I can tell you is it initially went like this: I asked my PCP for referral. (which I guess is what you've just done?) then I scheduled to go to the next info class @ shadelands this is required to gain admittance to "bariatric orientation" which is the next step. After that class they can set you up with a date for that if you wish to continue. Then you can attend that, then you would be able to have a consult with a Kaiser surgeon which is what larra was talking about. From that point on though, your course i am not familiar with, but others can fill you in with that! I'm SO close to you, and no kidding, WOULD love to walk the trail with you sometime! (if you don't mind the company of a kid or 2). However, like larra also said, you might want to wait at least till your "official" weigh in at orientation before losing any weight!!

[keliblue]

You and I started out about the same stat's.. I didn't go thru Kaiser but still had to fight every step of the way with Diana's help and Dr Rabkin is SF. You can get a lot of information on how to get your DS from dsfacts .com I'm up here is the mountains near lake tahoe.. welcome aboard

keliblue

[bigcoop]

Welcome to the site. Hope you get all the help you need...

[divanessa]

Hi everyone! Omg...I guess I've been a victim of the dreaded "unable to access this board if you have AT&T 3G"!!! I have been literally pulling my hair out trying to figure out why I can't long in or post;-( Finally I read the "Must Read" post on the main board and it explained the situation. Thank GOD!!! The info you all have given me is sooooo important, I wouldn't know what to do with out you all!!;-)

Anyway, I have my first WLS class on Wednesday. Diana and Larra- at exactly which point do I request to have the 10% waived and to whom do I discuss that with?
Larra, I know you mentioned that Kaiser will deny that and I have to get the DMHC to approve it. I went to their website, which form do I fill out to request their help with getting the 10% waived?

I feel so bad that I have NO CLUE what I'm doing and I feel like these might be dumb questions, but I am sooo paranoid that I do this right to the T so I don't waste any time.

Is it ok that I look to all of you to hold my hand through this?! I would mean so much, and as you said Larra, I would be more than happy to pay it forward to a lost soul like myself, once I come out of this on the other side.

MrsS, I'd be happy to meet up with you and your children to walk the trail! I love kids, I am a preschool teacher after all;-)

Thanks, Keliblue and Bigcoop for the welcome!

[goodkel]

Welcome!

Sorry about your trouble getting on. But, now that you're here, things will keep getting better for you.

I'm glad you didn't give up!

[mrss]

I forwarded you the links to the DMHC and ASMBS position papers on pre-op weight loss, and some other info! I asked the same thing when I was first starting out lol

[Peggy]

I am just going to say GOOD Luck and just don't give up this is such a worth wild .. I am too am kaiser no California but my bmi was high enough for no appeals .. Just follow what Lara and Diana tell you to do ..

[SLVinNorCA]

I'm late to the train, as usual! lol.

But I want to add, that your height matters too. Round DOWN, For example, If you are 5 foot 2 and 3/4 inches. Just tell them 5'2".

My situation was different than yours (BMI over 60) it took me 4 months, 24 days to get surgery. And that was waiting for the first appt with PCP, then class, orientation, etc. It SEEMED like forever, but looking back it was fast.

To answer your other questions, nothing really happens til you get your appt with your Kaiser Surgeon, Denial, then appeal. There are forms at every Kaiser facility hanging on the wall in the lobby or near elevators. You'll want to get started on those because the more tweeking you do to them, the better.

Welcome to the best WLS resource on the WWW.
Best of Luck and Congrats on finding this place.
Sue

[bigcoop]

HI SUE !!!!!! HI PEGGY HI LARRA HI DIANA HI GAIL HI JAMIE AND HELLO TO YOU TOO KELIBLUE. HOPING TO ONE DAY MEET MY CALI NEIGHBORS

[divanessa]

Thanks for the advice, everyone! I've got my first class on Wednesday. I was able to connect with Mary (yay for new friends!!) and she advised me to stay tight-lipped about wanting the DS until I get my meeting with the surgeon, and even then, I need to not mention it until I've been able to get the 10% waived. So I'll keep you all posted on my progress!! Thanks again, everyone<3

[Gail R]

This month, Feb 13 is the support meeting for Dr. Rabkin's patients and prospective patients. You ought to start attending ASAP. You will find a lot of information and inspiration there. It is fairly certain that Dr. Rabkin will do your surgery.
www.paclap.com/support/meetings-calendar.cfm

[dananicole7]

Hi divanessa! I just wanted to know what steps did you take to get that 10% preop weight waived? Thank you!

[Girlrocker]

And I'm late to the welcome party too! I don't have Kaiser knowledge, but I'm Sharyl, had my RNY (from 2002) revised to the DS in December 2012. I'm a southern California neighbor (originally from Chicago).

You are absolutely in the right place for the best advice, support, information. I highly recommend reading away, go back for pages - usually easy to spot updates, we all try to title them so they are easy to track, research - so you can read up on being pre-op, newly post op, etc. Also look at dsfacts.com if you haven't already.

Ask away - you will get answers, support, hand holding and a kick in the ass as needed here

[PrettyGirlBounce]

Just wanted to say welcome to the boards...it really is an awesome place rich with support and invaluable information.

[goodkel]

Jun 27, 2013 4:14:10 GMT -5 dananicole7 said:

Hi divanessa! I just wanted to know what steps did you take to get that 10% preop weight waived? Thank you!

This thread really belongs in the Insurance area. I'll move it later.

But you should read the threads there, they may help you:

weightlosssurgery.proboards.com/index.cgi?board=insurance

[galaxygrrl]

Hi all!

Bumping this old thread again and looking for some advice on process. I'm in San Francisco. And I want to get the DS and NOT the sleeve, I feel strongly about this. Right now I have Aenta and they will cover 1/3 of the surgery. If I move to Kaiser in january, it looks like they will cover almost everything.

My question is how does the Kaiser process work in No Cal. Assuming my coverage starts 1/1. And I will go to the drs office the first week of January. I'm wondering what the process is like the time period.

(1) How long will it take to be referred to a surgeon?
(2) What is the "Options program" I read about and how long is that
(3) Does it take time to get in the options program? I saw some video where it took a woman 4 months to get in the program.

Thanks for your help!!!!

[zarabear]

At my bariatric orientation right now. Dr spoke to us and mentioned 60 bmi for ds!!
I am very sure that I'd like to preserve function with the ds surgery and I'm getting a bit anxious over the denial process. Would love any input or direction!

~Rachal