Advice for Kaiser Patients Who Want the DS (Sher update)
I wanted to let everyone know that the DMHC did not rule in my favor. I’ll be getting the paperwork in a few days so I won’t know the exact wording until then. However, I was told my by caseworker that the DMHC said that they’d uphold Kaiser’s requirement for the Options Program because there was no documentation of my 6 months supervised weight loss. Now, I was with Blue Shield at the time (just joined Kaiser in January of this year) and they didn’t offer any weight loss programs. What I had to do was see my PCP. He did not give me any diet plan. I would come in whenever I needed to (for illness or whatever) and explain that I was trying to loose weight and that it wasn’t working. The same thing went on with my Endocrinologist. He’d see me every 6 weeks but there was no real documentation of weight loss, food intake, or exercise. He even prescribed a specific diabetes medication to lose weight (Bieta). I asked my caseworker if would make a difference if I got a letter from my former PCP or endo that I’d come in to discuss my progress multiple times over 6 months, would that be helpful. He said no. He said the review board is looking for medical notes in my file that show SUPERVISED attempts at weight loss. So, it’s done. I only have another 5 weeks to go (after this week). I’ve surrendered to the process and I’m going with it with a smile on my face because I know I’ll have the DS sooner or later.
I asked about the decision regarding mandatory weight loss prior to bariatric surgery and the caseworker said that that issues wasn’t even mentioned. It only said that they would uphold Kaiser’s recommendations. I explained that in the past the DMHC has ordered Kaiser to waive the weight loss requirement. He said that he’s pretty certain that if I went through the program and was denied based on my lack of weight loss that he’d be able to call them and convince them to waive it. I’m not certain of that but I’m hopeful. I’ve lost a few pounds since starting the program and I’m going to start doing protein shakes for one or more of my meals each day—hoping to drop a few more pounds. They want me to lose 25 pounds—if I drop 15 or so, maybe that will be enough for the doctor to see that I made an effort.
So, that’s where we are. I do appreciate all of your help these past few weeks. I wi**** wasn’t for “nothing". However, I do believe I have learned a few things to pass on to others who will be in my situation in the future:
Advice for Kaiser Patients Who Want the DS:
1. Get referral from MD and sign up for Orientation—you really MUST attend.
2. Don’t see the surgeon before appealing to the DMHC. I saw him before appealing to them and then HE ordered that I take the classes. This order is one of the things that messed things up for me. It’s clear that he had some impact on the outcome. Really, it’s best to avoid seeing any surgeon at all until the DMHC as come to a decision.
3. Get documentation of weight loss attempts—don’t do it on your own. I did all of my dieting and exercising on my own and didn’t make a doctor document exactly what I was doing. The review board wanted exact details from my doctor’s records showing what I was doing and how I was trying to lose weight. I didn’t have ANY of this information.
4. Start the process with a grievance to appeal to Kaiser to give you the DS and to waive the Options Classes and weight loss requirement—attend orientation so that it shows good faith that you’ve learned which surgeries Kaiser generally offers. Send first grievance form. Let them send 2nd grievance. Then send grievance letter to DMHC. Kaiser may offer to send you to a surgeon before hand. DECLINE this. The surgeon WILL SEND YOU TO OPTIONS CLASSES. Kaiser surgeons are instructed to do so. Once the surgeon sends you to classes, it may be a lost cause. They’ll include in their info to the DMHC that the surgeon specifically requested YOU go to Options.
5. Don’t discuss your decision or interest in getting the DS with ANYONE at Kaiser. The bariatric program will give you nothing but misinformation. The nurses, NUTS, and doctors will give you nothing but misinformation. The only place you’ll get accurate information will be research that YOU DO outside of Kaiser. Look for long-term studies, comparisons between surgeries, and talk to the veterans who have already gone through the surgery. LISTEN to them. They will be of tremendous help. Oh, and visit www.dsfacts.com .
6. Pay to see a surgeon outside of Kaiser for a surgical consultation—if he/she will write you a letter stating that he will provide the surgery, then you’ll have that to add to your Kaiser and DMHC grievance. You will have to pay out of pocket to see an outside surgeon. I made an appointment to see Dr. Keshishian but canceled it when the Kaiser surgeon agreed to give me the DS. I should have gone to see Keshishian just to get a written letter stating that he was willing to do the surgery. I’ll always wonder if that would have helped my case with the DMHC.
7. Sit tight and wait for the DMHC to decide your fate. It took then from July 15th until August 20th to decide. They actually had until September 9th. That’s nearly 2 months time waiting.
8. This brings me to my final point. Go to the classes. It will suck at first. You’ll realize right away that they don’t pertain to you or your surgery—AT ALL. The nutritional information they offer will be of no help to you after you get the DS. The teachers don’t know **** about any of the surgeries either—I could write a 10 page paper about the misinformation they are teaching about the Sleeve, RNY, and Lap-band. They are just talking heads there to pass the time and fill your heads with information that will ultimately help you to gain the weight back (at best) or get sick and die (at worst). BUT, BUT, BUT, when I finally received my DMHC decision, I’d already gone through 7 of the 12 weeks. That’s more than half way there. If I had declined attending classes, I would be 7 more weeks behind getting the surgery I’ve needed for YEARS. It was worth attending them—even if the DMHC had ruled in my favor. I did the right thing and I’m getting through it. AND, I just had my first DS discussion with a fellow student who was interested in getting the sleeve. She’s actually coming onto the OH board to ask questions and looking at DSfacts.com. So, the time wasn’t totally wasted.
9. One last thing I’d want any Kaiser bariatric patient to know: Surrender to the process! It was about 2 or 3 weeks into the process that I realized that I just needed to surrender and go with it. Today I learned something new—part of our homework was to get 5 different sources of protein supplements—they had to have at least 20g of protein, be sugar free, and have around 200 calories. Though I KNOW I’ll need more protein for the DS, I would have never gone searching for these products until right before my surgery. I got to learn a bit about the products and feel more informed now. Had I not surrendered to this whole process I don’t know that I would have been able to be open to getting the homework completed. Don’t be bitter or angry—ok, you can be bitter and angry for a week or two, but then you need to get over it. It’s counter productive. This is harder work that I’d though it would be but I’m getting through it and in the end, I’ll have my DS!!!
Thanks again to everyone who has helped me through this process and with MY journey. I'll keep you posted!
Sher-
I’m posting this email on the board to help others
This was such a helpful read. Thank you for taking the time to lay it all out in a post. I'm sure it will help more than one person in the future.
Wishing you the best possible outcome....
