Are there any Kaiser Permanente NorCal DS surgeons?

Researching DS surgeons in the KP system and would like to know if anyone has had this surgery with one or knows of anyone that has. Thanks for your responses.

I would check with the Rabkins in San Fran or Keshnian.  DS surgeons are few and far between, so if you have to travel within CA, consider yourself lucky because many have to cross state lines.  I can warn you that Kaiser can be squirrelly about the DS.  5+ years ago, getting the DS always requied an appeal or two.  I've not heard so much about having to do so in a long time, so perhaps they got their act together.

Thanks Valerie. I work for Kaiser so I am well versed in the referral process. I just wasn't sure if any of the surgeons at Kaiser do the DS. Even working here I am finding it difficult to find out this answer. I have to have the DS because I have severe arthritis and need a knee replacement now. They are hesitant to do the knee replacement at my age (too young) but absolutely will not do it at my weight. I went into the VSG with the understanding that the DS was an option if needed. It is definitely now needed so I can get off and keep off the weight so I can get my knee replacement and get back to enjoying life again. I may have to see Dr Ungson, but my first choice with be Dr C if I can get Kaiser to cover it.

Dear SuperRN597, I am considering a DS and have Kaiser (Northern CA) and had assumed I would have to self pay, I would love to know if you are able to get a referral out of Kaiser for it.  I am at the very beginning of the process with Pacific Laparoscopy, am hoping to have surgery in January of 2016.  I weigh 275 and am 5' 4", not sure if that puts me in the over 50 BMI category.  I also need a knee replacement (actually two) but have two major trips planned over the next 9 months and have to wait until after they occur to do the bariatric surgery.  Will then see if the knee replacement has to happen after that.  

Here is the bottom line:

No bariatric surgeon in the NorCal Kaiser system does the DS. Kaiser patients who want the DS AND who have a bmi over 50 AND who know enough to request the DS are sent outside Kaiser to Dr. John Rabkin of Pacific Laparoscopy in San Francisco for their DS. Patients with a bmi under 50 *****quest the DS get a denial regardless of their cir****tances and must go through internal and then external appeals. The internal appeal will be routinely denied, the external appeal through the DMHC (dept. of managed health care) is often successful.

HOWEVER - you have, I gather, already had the VSG and now want revision to the DS. Kaiser routinely denies all revisions. So, unless your Kaiser bariatric surgeon PROMISED you that if your vsg didn't work out he/she would authorize you for the DS, which I guess is possible but I've never personally heard of this happening, you will get a denial and then need to go through appeals. Where it will go from there, I can't say.

I will also send you a pm.

Larra

Thanks Larra. The good news is that my VSG was done outside of Kaiser before I was a Kaiser employee/member. I do not qualify for a DS on BMI, but with my co morbidities I should. I can't have the RNY so DS is it. My original surgeon did tell me DS was a follow up option if needed. I was 67.3 BMI to start. Being an RN and having you PCP behind me with my original surgeons recommendations, I feel my chances are better than most. I will check out Dr Rabkin but will push for the surgeon that knows my anatomy and has been there before. I don't think that is unreasonable. Thank you for the info on the Kaiser DS options.

Sharon, I'm sorry but this is not such good news. Going to DS from VSG is still a revision, regardless of what insurer, if any, paid for the first operation or what surgeon did it. I can almost guarantee you that Kaiser is going to say either or these things, or both:

1. you were noncompliant. they will say this regardless of whether they have any evidence of your noncompliance. In their eyes, anyone who does not succeed with a prior bariatric surgery, unless there is a specific anatomic problem, was noncompliant. Now in reality this is not the case, but this is what they will say.

2. Your policy does not cover revisions. So you need to get your hands on your EOC (evidence of coverage) and see exactly what is covered and what isn't as regards revisions. Keep in mind, though, that depending on your medical condition it might still be possible to appeal, but you will have a fight ahead of you.

Having your pcp "behind you" will not help. Your pcp's does not get a vote. The original surgeon, who is not part of the Kaiser system, also will be disregarded.

AND, if somehow you do get Kasier to cover your revision through appeals, it will be with Dr. Rabkin, because they have a contract with him for the DS. I understand your desire to go back to someone you already know and who already knows you, but you don't get a vote either. Fortunately, this is ok, because Dr. Rabkin is a very experienced DS surgeon who does many revisions, including RNY to DS revisions which are much tougher than VSG to DS, so you would be in good hands.

I'm sorry, but these are the realities of the Kaiser system. To anyone else reading this who is considering the DS, the takeaway message is not to assume that if you try some other, "less invasive" operation first and it doesn't work out, you can always try the DS later. Maybe you can, but getting your insurer to pay for the second operation may be impossible.

Larra

I see. I will definitely find out details on the coverage. I feel an appeal coming. I will fight for it while I work overtime to gather the money to go to Mexico with Dr Ungson, if necessary. I really have no choice. It was menopause and medications that halted my weight loss. Then the failure of my knee further complicated things and I have had some gain. I'm still 200 pounds less than My highest, but I need to lose 75-100 more to get the knee surgery I desperately need. Thanks again for the information.