Does anyone have Kaiser Insurance?

I would like to know if anyone has Kaiser in the Lakewood, CO area and would like to know their experience in getting approval for WLS?

I'm a patient at Kaiser Lakewood. I was originally approved for surgery, and after a year on the waiting list, the surgeon with whom Kaiser contracts for lap RNY denied my surgery. He refuses to operate on anyone with a BMI over 60. I'm trying to appeal for surgery with an out of network surgeon, but I think Kaiser will end up not approving it because "a Plan surgeon doesn't think it is necessary." If I were a Kaiser member in California, the CA Dept of Managed Care would make Kaiser pay for my surgery. I don't think the CO Dept of Insurance will make Kaiser do anything Kaiser doesn't want to do. We'll see. Kix

I'm so sorry to hear about your situation. I currently have a BMI of 45.6, so maybe I won't have the same problem. I am just now looking into the possiblility of surgery and am wondering how hard it is to get approved. Thanks for your response, I really appreciate it! Good luck to you and I hope you get your surgery approved! Don't give up!

I have Kaiser insurance, and I'm thoroughly disgusted with the way they handle gastric bypass. When I finally decided that I wanted the surgery, I contacted them and was told that I would have to go on a diet for a year and then be on a waiting list for 2 years. Ridiculous! Then they said they would only do open. I ended up cleaning out my savings and investment accounts and paying for my own. It was worth every penny of the $25,000, but I am still resentful that Kaiser is willing to pay for all the co-morbs, but not to prevent them. They have also decided that they will cover NO reconstructive surgery after gastric bypass, no matter what. So now I'm saving up my pennies once again. I recommend that you "bypass" Kaiser if you can. As a corporation, I think they hate fat people. You can probably read a little bit of anger in this post, huh. I will be changing insurance companies as soon as I can. Because I was a cancer patient, no one would take me until I was five years out. Another plus is that I have had plenty of motivation to stay with my program. In two years, I haven't eaten any sugar or anything with white flour. When I think of eating something that's not good for me, I just remember the $25,000. Good luck to you. I hope your experience is better than mine. Maybe in the years since I tried to get them to help me, they have developed some sensitivity. I hope so.

I totally understand your anger. I feel the same way. I attended their Weight Connections classes, met with the weight counselor monthly for a year, and lost a grand total of 20 lbs. Instead of paying for me to have surgery from an out-of-plan surgeon, they think it's reasonable to go on Optifast and lose 150 lbs so I can use their contract surgeon. Until then, they deny me surgery under the guise of it not being "medically appropriate." It's all semantics. In the meantime, I have to live with disabling comoribidities. The way Kaiser treats its clients is both ethically and medically wrong. I'll probably end up paying for my surgery, too, once I am able to save enough money. I don't think my attorney will be successful in getting Kaiser to cover it. Kix

I actually had a decent experience with Kaiser. I was on the waiting list for a year and during that time I was working on my weight but it was not their requirement. I had surgery in April and have lost a total of 104 lbs from my highest documented weight. I am a bit disgusted that they have completely excluded P/S due to bariatric surgery whether it is medically necessary or not. My PCP says that I will have to have P/S to remove the skin no matter what - for varying medical reasons. I am lucky tho, my BF's insurance will cover it since it is medically necessary in my condition. I will be switching to his insurance next spring so that when the time comes I will have met all waiting periods etc. When we go on a cruise summer of 2007 you better believe this body is gonna look good in a swim suit. Kimberley

I have Kaiser and I have been generally pleased with their coverage until my request for WLS. They denied me. They are, quite simply, rationing healthcare, which should be illegal, but isn't for an HMO. I have retained an attorney to not only fight for myself, but also to take a stand against these behemoths for everyone that can greatly benefit from surgery.