DS approved! But...
Saw my surgeon today and he approved me for the DS!!!! Yay! I got over my very first hurdle (with a lot of help from Bookfaerie--thank you very much). The doctor said he'd do the surgery and actually seemed pleased that we were there and knew so much about the procedure. He even said he wished he had more patients like us! Not more patients with the DS request, just more patients who knew their **** (please excuse the language) about their procedure.
That being said, he did not wave the Options classes. He said he had no problem with me not taking the classes but didn't want to deal with the aftermath from Kaiser if he waved them. So, I checked to see if my appeal to Kaiser had been approved--but it was denied. I sent in my DMHC appeal 7 days ago--it's in the pipeline there and has been sent to a case manager--but no decision has been made. So, I'm just hoping that they'll agree to wave the classes. The surgeon said that as soon as I got the OK from the DMHC, he'd schedule my pre-op and surgery! Yay! In the meanwhile, I'll see if I can get back in the classes (today was the first and I missed it because it conflicted with the surgeons appointment) to pass the time as I wait to hear from the DMHC.
So, send happy thoughts to my grievance!!!
Sheri
HW/SW/CW/GW 346/335/183/150 5'4.25"
This is unprecedented. Really. I am flabbergasted (but in a GOOD way)!
This is a red-letter day for the DS.
The DMHC grievance to force Kaiser to wiave the options class is pretty much a shoo-in. It just may take another couple of weeks. You might as well sign up for the classes - perhaps you could pay it forward by telling people in the classes that you attend while waiting for them to be waived, that they can file a grievance too.
Congratulations!!
I'm starting class next Friday--I intend to spread the word about the DS--covertly of course. I'll be the undercover DS proselytizer!!! Hoping to come over to the dark side officially very soon, but for now it'll be by-proxy. Definitely paying it forward!
Sheri
I hope you didn't misunderstand - I know you and Bookfaerie worked really hard to position your situation as best as could be done, and you are to be commended for that - I'm sure it wouldn't have been possible without that as well.
But the fact is, Belzberg on his own, without being forced by the DMHC, without getting approval of higher-ups, without it being a formal waiver of policy, and presumably without a written policy change (unless you can find it?), was allowed to agree to do a procedure that Kaiser has FIRMLY AND STUBBORNLY completely opposed. THAT is what flabbergasts me.
I'll tell you what, it defintely brought us closer together! You can't go through something as life-changing as this and not get closer to the person who is by your side. I'm grateful as ever to her!
Oh, and thankful to you Diana and to Larra as well--for putting me in touch with Bookfaerie.
Any thoughts?
Sheri
The grievance process relates to procedural issues, like the requirement for taking the Options classes. To my knowledge, you don't even have to go through the charade of asking them to waive the classes - once you were given the requirement to take them, you were eligible to file a grievance with the DMHC to ask them to order Kaiser to waive the requirement.
The other process is the IMR review process for refusal to provide care, either due to an allegation that the requested care is either experiemental or not medically necessary (two different paths, both going through the external IMR process), which are substantive issues. For those appeals, you have to exhaust the internal appeals process with your insurance company/plan, before you can file for an IMR.
Sheri
