Kaiser permanente

Does anyone know how to get approval from Kaiser?  I am joining Kaiser for this purpose.  Please advise

Your primary dr.  has to refer you to the bariatric clinic, and then your journey will begin.    If you don't have a primary dr.  ask on all the boards for a kaiser dr in your area that has referred them.  then call and make an appt for a checkup.

Good luck!

Thanks for your quick reply.   This inquiry is for my daughter.  She is about to purchase Kaiser insurance, but can't find out what the criteria is for WLS there.  We'd like to know before we actually start the process, because if she won't qualify, then she will not spend the money, but rather become self-pay elsewhere.  Kaiser Bariatrics in South San Francisco won't say what the qualifications would be, or anything else about their program, until you actually get referred.  I am told by a few people that everyone under a 40 bmi gets refused even with co-morbidities.  She has a 36 with sleep apnea.  You'd think that would be okay, but after all, they are their own insurance company and are more likely to deny than approve.  

I know they must approve some people because they have a bariatric center.  But does anyone have any experience with them?

 

Roberta

I can't say for sure what Kaiser SSF demands to get into their program, but I will say that if your daughter meets the NIH criteria for medical necessity for bariatric surgery and gets refused, she could file a grievance over this. If Kaiser still says no, she could take it to external appeal through the DMHC (dept. of managed health care). Of course I can't say what the results of this would be, but hopefully the denial would be overturned.

It does seem to me, though, that you should be able to get the criteria for entry into the bariatrics program, which is a regional program, somehow, rather than paying to get into Kaiser and then taking your chances.

I should also mention that if your daughter wants the DS (which you and I both have) she will definitely have to fight for it. With her bmi being below 50, Kaiser will not authorize it for her. That one would definitely go all the way to the DMHC, and while many denials are overturned, there is never a guarantee.

Larra

Hi, Im just getting started at Kaiser Fremont. My understanding is that they approve under 40 BMI with two co-morbidities. The Fremont website has tons of info here:

http://mydoctor.kaiserpermanente.org/ncal/facilities/region/gsaa/area_master/departments/Bariatrics/binder.jsp

 

I don't know if SSF process is the same, but the Fremont info should give you a good general idea.

 

So far I've attended a 2-hour general info meeting, then PCP referred me to Bariatrics. Had psych eval. I'm on antidepressants so the psych is checking w/my therapist to make sure she has no concerns. When that's cleared, next step will be the long orientation where the surgeons and others talk.

Hope that helps some.

Tell her to not join the network. I AM a member and I was denied. I have been fighting for months to get an approval. I have more then qualified for the program. They will find any reason to not do it. It is just easier to join a better network. Unless she has no other choice. Then it many be many months battle to get them to approve you. Good luck!  I hope SF is a little easier then LA.

I got approved fast. Although ian from san bernardino county and you have to attend a 3 month bariatric classes called options. After taking the class I was scheduled for rny in 2 months.. I had no co morbities, no sleep apnea no diabetes. Nothing. I loved kaiser!

I am not a Kaiser member but the support group I lead has a majority of Kaiser patients throughout the San Francisco Bay Area.  One thing I have seen is that Kaiser really "tests" patients to see just how serious they are.  Think of it as a way to weed people out so only the "best" patients get to the operating table.  I know many get impatient jumping through all their hoops but I honestly think it is a good thing so the patient has more time to prepare, such as really slowing down and actually chewing food, getting used to supplements, drinking water (amazing how many pre-ops don't drink water) and so on. 

Jump through the hoops, be patient and it will eventually happen.  Keep in mind that Kaiser has thousands of patients going through the bariatric program and often only has 2-3 surgeons to handle that many so there are often delays.  Stay on their radar and be the squeaky wheel when you feel you are falling through any cracks.  It's likely you are as the supply isn't keeping up with the demand.

Best of luck,

I had surgery at Kaiser SSF in March. The criteria for referral are BMI greater than 40 OR BMI greater than 35 with ONE serious comorbidity, like diabetes, moderate or severe sleep apnea, hypertension on multiple meds, PCOS. Probably some others. There is a required overview class to complete before the referral, but the process can be very fast. After the overview, I was referred and accepted and in orientation in a little over a week. Completed all the required things ( wt loss, psych, nut) and saw the surgeon within another 4 weeks. He offered me a surgery date that was 3 weeks away, but I was not ready to take the leap. I ended up waiting a couple more months to get it done, which was the right thing for me. Don't let people scare you away from Kaiser. You can get top notch care there. I would be happy to answer any more questions you might have.

I too am just starting the Process with Kaiser. I am going to a "getting prepared" class tomorrow afternoon, which i understand is the first step. Its free to members and i didnt need a referal. I just needed to call and register. My question, which may get answered tomorrow is "now what?". Do they hook u up with a sergeon and go from there? Or do i need to go back to my primary? Also someone please tell me what a "NUT"is? Reading abreviated words and not knowing what they mean is like reading amother language. Thank you