Kaiser (state employee) Requirements?

Good evening!  I'm hoping someone here can help me.  I've read my benefits coverage book for Kaiser and it states that it does not cover weight loss in any way shape or form.  I read on here that a couple of people have been approved using Kaiser in the last couple of years - how do you even broach the subject to discuss it if it's not covered by your insurance company? 

Your post indicates you are a Georgia state employee.  The state of Georgia, in its infinite wisdom, has excluded WLS from all their policies.  The state of Georgia has a "self-funded" plan.  The fact you have Kaiser (I have UHC) means nothing.  The state of Georgia is the one that decides that exclusion, not the insurance company. Now (as I get comfy on my soapbox) I think it needs to be fought.  Until people start fighting them for WLS, they will not change their policy.  I am currently pursuing WLS.  I'm jumping through the surgeon's hoops (nutritionist eval, psych eval, pre-op testing, etc) which I will finish this week.  I have 4 doctors writing me letters of medical necessity too.  I anticipate I will get a denial once I send all my info in.  Then I will hire an attorney (I've already been in contact with one) in addition to writing the governor, the insurance commissioner, the superintendent of my school system, my local representatives and anyone else I can think of.  (stepping off my soapbox now). -Elli

Wow - are you paying for all the premliminary stuff out of pocket then?  That stinks!  But you answered my question, even if I don't like the answer. 

Actually, I think insurance is going to cover most of the prelim stuff.  They paid for the initial surgical consultation (minus $25/copay).  I'm sure whatever code the doctor's office used is just a general surgery consultation code doesn't specify WLS.  I had to pay out of pocket $50 for the nutritionist consult.  The preop upper gi, ekg, and blood tests are coded with obesity as a secondary diagnosis.  Primary diagnosis is "esophageal reflux" which should be covered without question.  Not sure yet about the psych eval.  I scheduled with 1 doc and the lady in the office called the insurance.  They cut her off at the knees when she said the words "bariatric surgery" and said they wouldn't cover it.  She told me to call them and indicate I was "depressed about my situation" and said they might cover part of the eval.  I called the insurance, didn't say what I wanted to see a psych for (they didn't ask) and they gave me an authorization number.  Then they indicated the original doc I was going to see was not in their computer, so I picked another doc who is on the insurance and made an appt for this week Thursday.  I am keeping my fingers crossed that they pay for all or part of the psych visit.  If not, yes, I will pay out of pocket.  So the answer is, I'm trying to get them to pay for as much as possible. Have a good evening.  And good luck whatever you decide to do. Elli

To be honest, I'll probably wait.  My husband is getting laid off this fall and we'll pick up my insurance which covers medically necessary procedures and several women at my office have had the surgery.  Knowing my luck I'll start the process and they'll drop that clause for 2009!    I do wish you lots of luck!