Kaiser WLS: They will cover the DS and NOBODY has to do Options or diet or classes in any...

Kaiser SAYS they don't cover the DS, but did you know that with ONE exception (that was ultimately rectified), the CA Dept. of Managed Health Care has forced Kaiser in EVERY SINGLE APPEAL since mid-2004 to pay for the DS?  EVERY ONE OF THEM.  And in NorCal, they have, to my knowledge, paid Dr. Rabkin to do them - one of, if not THE best, DS surgeons in the world.  SoCal Kaiser now has a DS surgeon in-house - Dr. Belzberg.  He's not very experienced, and I'd be willing to bet his aftercare program sucks, but he's in-house.

Do you have to file and appeal to get it?  Yup.  Is it worth it?  Ask someone who's had a DS.

Kaiser SAYS you have to do their pre-op bariatric programs, which put its patients through MONTHS and MONTHS of delay.  Did you know you don't have to do that?  If you file a grievance directly with the CA Dept. of Managed Health Care, 30-45 days later, they will order Kaiser to waive all that bull**** and send you on your way to surgery without delay.  File a grievance when they send you to these classes, and cite this document: http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf

I don't have Kaiser but I know a few people that have gotten their surgery through Kaiser. I think going through some type of program or classes before having a major life changing procedure is a very good idea. I just looked online and their pre-op WLS class is 14 weeks. That really isn't months and months when you consider the need to lose weight prior to the surgery.  The people I know that have gone through the program together and gotten the surgery have formed some very strong friendships and support of each other.

I agree that every patient having wls should be well informed. But the 14 weeks isn't just 14 weeks. Many people have posted about waiting several months just to start the Options classes due to lengthy waiting lists.
     And the point here isn't that people who feel they would benefit from these classes shouldn't take them. The point is that people have a choice, and they don't know they have a choice. I've read posts from people who loved the classes and met some great people there. I've also read posts from people who felt the classes were very repetitive, and that the months (yes months) of waiting list and classes delayed much needed medical care for their MO and comorbidities.
     And the need to lose weight prior to surgery thing - another requirement that can be appealed successfully, so no need to wait months for that either. Again, if people WANT to lose weight pre-op, fine. But for those who can't, this is just another barrier to needed medical care.

Larra
    

What "need to lose weight prior to the surgery?"  NEED?  There is no need.  Several studies have conclusively PROVED that pre-op weight loss does NOTHING to improve outcome of bariatric surgery, either in the short run, or in the long run.  ALL IT DOES IS TO DISCOURAGE PEOPLE FROM GETTING SURGERY!!  IT IS AN INSURANCE COMPANY FRAUD THAT SAVES THEM MONEY WHEN PEOPLE GIVE UP.

While this may be true of some it is certainly NOT the case for ALL.  I for one have NOTHING but supportive friends and have for decades of my life and did all the research prior to the Options classes.  In addition (while I understand it's NO longer 6 months) which is why it's 1/2 that now because the classes were often repetative and really didn't come close to dealing with LIFE after WLS.

Ms Shell

Having just finished the Options class, I feel like I got nothing from it. I lost my 10% in the 12 weeks though, which I'm not sure I would have done without it.

However, most people, as much as they hate it need to do the program. 90% of the class I was in - they didnt lose any weight, they still came to class and talked about gorging all week on fried/fatty food, and all expressed in one way or the other about this magical cure to obesity and they seriously believed they are not going to have to put in the work.

But, Kaiser is a big pain in the A** just to get in, with long wait lists and such, so this information is definitely useful if someone wants to avoid that. I think OH teaches more than Kaiser's class

The classes and mandated weight loss requirements are like fraternity hazing.  They discourage people - only the stakes are much higher.  There is an element of sadism and callous disregard for people's health involved as well, because several studies have proven that there is no meaningful reason for the torture and delay. These are simply tactics used by the insurance companies to deny medically necessary treatments to the most vulnerable of their insureds.

And interestingly, those who have BEEN through the hazing are more likely to try and rationalize and justify the need for them - because it makes their needless suffering meaningful.

Thanks for the feedback on my comments. It made me think more about this. Like I said, in my orginal post, I don't have Kaiser so I've never had to deal with their beaucratic garbage. After I posted this last night, I was thinking about the length of the classes. 14 weeks does seem like an awefully long time and would most likely become very redundant.

The program I'm going through requires one seminar, attendance at monthly support meetings, meeting with a dietician and a therapist.  I learned a lot at the seminar, find the support meetings helpful but didn't find the dietician to be very helpful. My best experience has been in meeting the therapist. I was the most nervous about that part but she was the most encouragining, positive person that I've met during the whole process.

MsCox-you said in your post that losing the weight pre-surgury doesn't make a difference. Could you provide me with some documentation to support that? I would like my surgeon to do my surgery before I've lost the 10%. I'm very ready now. The main reason he told me it was necessary to lose the weight prior to surgery is to help shrink the liver. He said it is safer to operate with less liver in the way. I'm also currently just over the weight limit for the hospital where I want to have the surgery. I figure the pre-op liquid diet would take care of those few pounds and most likely shrink my liver.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925384/?tool=pu bmed
In many practices, preoperative weight loss is an implied surrogate for intrinsic motivation, and thus a predictor of postoperative success [10, 11]. In fact, in some centers preoperative weight loss is a prerequisite for bariatric surgery to assess patient compliance, although there is no evidence to support preoperative weight loss as an indicator of “intrinsic motivation." Yet in some institutions it is still used to deny morbidly obese patients bariatric surgery. It is unknown how many patients are denied surgery due to an inability to demonstrate weight loss preoperatively. In our study we sought to determine whether any preoperative weight change, gained or lost, was predictive of postoperative weight loss, and whether it is justified to use preoperative weight loss to assess postoperative patient compliance, and consequently operative success.

5. Conclusions Our study did not show any correlation between preoperative weight change and short-term postoperative success after Roux-en-Y gastric bypass. Therefore, we do not believe that potential patients should be denied bariatric surgery on the basis of their inability to lose weight preoperatively.
(There are references cited in this recent paper that you might also want to provide to your surgeon.)

It should be noted that the SINGLE study that I have seen (cited as ref. 16 in the paper above) relates to whether a pre-op SIX WEEK Optifast (= starvation) diet shrunk the liver, based on MRI measurement.  The answer was yes, about 14%.  However, there was NO study that I know of that compares the safety or efficacy of surgery with a smaller liver.  Even this paper used the careful words "The reduction in liver fat and volume likely accounts for the perceived improved operability in patients undergoing LAGB."  There is NO PROOF that a starvation diet or any weight loss improves outcome in bariatric surgery.

Personally, I think that insurance companies that put on this requirement are hoping you'll give up or die before getting surgery.  I think bariatric surgeons who put this requirement on their patients are fattie haters who are actually disgusted by their patients, and think they deserve to suffer.

Dr. Rabkin says that as a bariatric surgeon - and he does the DS on patients up to 800 lbs LAPAROSCOPICALLY - he expects to find a large fatty liver, and he deals with it.  He sees NO benefit to the pre-op diet, and in fact, a negative - starved patients come in low in vitamins, low in protein. dehydrated, and depressed.  He'd rather have a happy patient who didn't suffer, is well nourished and in top condition for surgery.  He certainly doesn't want us to GAIN weight pre-op, but diet?  NO.

Thank you very much!! I just read and printed out the article.