Kaiser grievance for DS
Hi all,
I know this question has been asked before and I looked for the answer in previous posts but I didn't find it. I had vsg almost 3 years ago and lost a total of 40 lbs. I am looking to revise to the DS. I already saw a surgeon at kaiser and he said he would do the rny which I don't want but agreed to it with the plan to file a grievance. The surgeon said to do the options program again. My question is, am I now approved for wls and I can file the grievance or do I need to do the program again and then file? A nurse called me and told me that the surgeon said that he would do the revision but my PCP needed to do another referral. My PCP sent another referral so options sent me the packet to attend the orientation. My fear is that I don't have anything in writing saying I am approved for revision. I have emailed the surgeon which becomes part of your record but every time he would call me so his reply is not on record.
By the way I am in L.A. SoCal Kaiser. Starting weight was 250 went down to 199 but gained 20 lbs. now
Any info. will be appreciated.
What surgeon did you see? There is only one surgeon in SoCal Kaiser who does the DS at all. This is Dr. Belzberg at Harbor City. Whether or not he would be willing to revise your VSG to a DS, I of course have no idea. I also don't know whether or not he would insist on having you go through the Options program again, which seems to me to be a waste of time, but it's not my decision.
Your post is somewhat confusing as well, because it is unclear to me whether the surgeon you have spoken with would revise to RNY, which you don't want, or DS. If he will only do RNY for you, I see no reason for you to continue any involvement with him.
Regarding the lack of a paper trail, It seems it will be up to you to maintain this. Even if he (and the nurse) continue to respond by phone, you can keep a record of name and job title of person you speak with ("the nurse" isn't good enough), date and time, and a brief summary of the conversation. Save all your own emails to everyone at Kaiser, of course. And do this for AlL conversations with people at Kaiser, not just the doc and nurse.
Larra
Sorry I didn't explain clearly. The surgeon I saw is a kaiser surgeon, he does not do the DS. I knew they would only offer the RNY and I agreed to it just to get approved for a revision. I saw him he said he will do a revision to RNY and said to start the options program. my confusion is, i dont know how to start the process. Do I file a grievance with kaiser now saying I changed my mind and want the DS instead of the RNY? The surgeon I would like to have do the DS is Dr. Keshishian.
I sent you a pm already...but will advise here that since Kaiser SoCal has a surgeon who is capable of revisng your VSG to a DS, they aren't going to authorize outside care for you with Dr. K.
I would recommend getting a consult with Dr. Belzberg in Harbor City Kaiser. He's the one who can do the DS. Whether or not he will authorize this revision for you, and whether or not he would require you to do the Options classes again, I have no idea. But to my knowledge, he is the only surgeon in soCal Kaiser who does the DS.
Larra
I'm thinking also that it would be helpful to get your medical records. If the first surgeon, whoever he may be, has offered revision surgery, that would mean that the only remaining issue is which operation to have, and NOT whether or not Kaiser will pay for a revision at all. That would simplify things greatly.
Also, patients of Dr. Belzberg have generally liked and respected him, but mention that he makes very sure anyone considering the DS knows all about it and knows what he or she is getting into. So if you haven't already, I would strongly advise you to read everything you can about the DS and know the pros and cons, know the vitamin and supplement requirements, and know why you think it would work for you when VSG didn't. You need to go into a consult with him well prepared. The best website for this is dsfacts.com.
Larra
Absolutely, I am well aware of all the supplement and vitamin requirements with the DS. Why the VSG didn't work I didn't really know. My doctor was saying I was taking in more calories than I should when I know I wasn't. The first year I was doing everything I was supposed to and only lost 40 lbs. I felt very discouraged because the surgeon kept saying it was me. Slowly but surely I stopped caring and started eating the wrong things and stopped exercising so I started gaining. In May of this year I had another upper GI and when I saw the surgeon that will revise me he showed me the film and I saw the report below the image and started reading it. The upper GI doctor wrote on her report that the Antrum was large. When I asked what that meant he said that he doesn't sleeve the stomach all the way to the antrum either and his patients do really well. So again, he was saying it was me. At this point I dont know.
I was very pleased with my DS and am. However that said you can fall back into eating the wrong things and no matter what surgery you had gain wt as I gained 20 pounds back with the DS. However that said although I have heard many ask if they broke their DS I do not think that is possible and if you get off the carbs one will reduce their wt again. I am in the process of doing that. As a precert nurse in an ins company we can only authorize on the federal side of the company a revision after 2 years. All ins companies have their own rules so you will have to find out what applies with yours. I wish you the best of luck. As a revision I am not sure if you will be considered a light wt but that is exactly what I am. I have found a lot of support on here so keep coming back. Those who are not supportive let it go in one ear and out the other you have to do what is best for you. My revision was from a Lap band to a DS and I have never regretted it once.
Wishing you luck on your journey to successful wt loss.
Donna
