Successful SoCal Kaiser Patients Please Help!

Kim... That diabetes thing sucks on so may levels! I had it and the surgery cured it! Yay! heres hoping for a close date!!

Not a kaiser patient but this diet nonsense can be put aside by getting the forms from the DMHC (CA Dept Of Managed Health Care) and file a GRIEVANCE, not a request for IMR (Independent Medical Review) to get them to force them to drop the diet requirement. Here is the DMHC document that establishes that there is no proper basis for requiring a diet: http://www.hmohelp.ca.gov/boards/cap/bariatricrev.pdf SUMMARY CONCLUSION There is no literature presented by any authority that mandated weight loss, once a patient has been identified as a candidate for bariatric surgery, is indicated. There is a mixture of results that question whether weight or truncal obesity is a risk factor for complications after bariatric surgery. The more analytic studies have not found that body mass index (BMI) or total weight is an independent risk factor for complications or death from bariatric surgery. No institution that has recently published data on bariatric surgery describes a protocol requiring weight loss between identification of the need for surgery and the surgery. Many institutions in California have published results of surgery with particular focus on factors that contribute to morbidity and mortality. No paper from a California institution mentions mandated weight loss before bariatric surgery. Nor does any literature regarding the treatment for the morbidly obese recommend continued weight loss during the period between identification of the need for bariatric surgery and the surgery. Mandated weight loss prior to indicated bariatric surgery is without evidence-based support. Mandated weight loss prior to indicated bariatric surgery leaves the patient at increased risk from the patient’s comorbidities. Mandated weight loss prior to indicated bariatric surgery is not medically necessary. Mandated weight loss prior to indicated bariatric surgery would be deviant from the standard of care practiced in the United States and other published countries. The risks of delaying bariatric surgery, while not entirely known in the short-term, are real and can be measured. Any potential value of losing weight prior to bariatric surgery is theoretical and not supported by any data. An experimental study including fully informed consent to determine if there were a reduction in risks or other benefit from mandated weight loss prior to bariatric surgery is indicated. Thanks to my friend D. Cox and reposted in part for your perusal here. It's a virtual certainty your mom would prevail and the overturning of the pre-op diet and options requirement at the grievance level would also streamline your mom's WLS approval more quickly. You can see these diet requirement overturning decisions yourself mixed in with others, although, these were done in the form of appeals on external review. http://tinyurl.com/42om93 Rockne

Dude... You Rockne!! Thanks!!

I initiated my quest for RNY through Kaiser in southern CA, when I was 58.  I was evaluated by my gp and told that I qualified. I inquired further. I was told I needed to show proof of a documented 6 month medically supervised diet program within the past 5 years. I had one such a program and I got a letter to that effect.  This was close to 3 years ago now, as I'm 2 years post of from my RNY. If I was unable to produce the proof, I would have to participate in their options program, a nutrition and Optifast program for reduction of weight reduction.   Even though I had the proof of the weight reduction program, I still had to participate in a nutrional education / RNY educational classes that are now 22-24 weeks in length.  Yes, I did have to get approved by a board within Kaiser for this program.  Kaiser referred me to an outside surgical group, with a great surgeon, Dr. David Suh. To date, he's done 9000 of the LAP RNY procedures.  He works at a Bariatric Center of Excellence hospital too. No problem with my surgery either.  Although it may be a long process to you, very few insurance companies will just pay for the surgery without some education on the subject beforehand.  It seems that many get a mind to have the surgery, and they want it now. I guess it's just a sign of the times, "instant gratification" with such things like the Internet, ATM's, cell phones, etc. DAVE

Dave, Thank you so much for your story. My mom has been considering some sort of wls since I had mine 3 years ago. She started working with her PPC many months ago ... I know it *seems* like she decided yesterday and wants it today but it has actually been in the works for awhile.  As for the hoops.. I am sure she is willing to do what is required if it is *reasonable* and frankly since she is at their mercy, even if it is NOT reasonable..  I find it interesting though how Kaiser, even within their own system, is so inconsistent as to what is "necessary". Thank you again for your info.. Rita

I never had to prove anything to Kaiser other than proving that I had a $15.00 co-pay and that I weighed 457 lbs.

Hey Gus!! Haven't seen you around the cheese bar on the ship lately! Kaiser is so inconsistent.. but I am glad that worked FOR you!! XOXO