Kaiser ?
I have Kaiser and I also work for them...if you meet all of the criteria (6 months weight loss, psych eval, sleep study, etc.) they should approve you. If they don't, they'll tell you what's missing.
The surgeon they recommend you to depends on where you live and your health status. If you are in Baltimore, I am not sure who they use, but down DC way, it will either be Brian Cantor at Holy Cross or Paul Lin or Juliette Lee at George Washington. I had Paul Lin at GW and he was fantastic and the hospital was also fantastic.
Hope that helps.
Erin
The surgeon they recommend you to depends on where you live and your health status. If you are in Baltimore, I am not sure who they use, but down DC way, it will either be Brian Cantor at Holy Cross or Paul Lin or Juliette Lee at George Washington. I had Paul Lin at GW and he was fantastic and the hospital was also fantastic.
Hope that helps.
Erin
Erin H 
Hi Lori!
I just finished the "6 month" Kaiser program on May 22 - although for me it was 10 months because my insane work travel kept me from getting to follow up appointments on any type of regular basis. I ended up taking classes at other centers, saw another Nutritionist once even, but got through it just fine - kudos to my nutrionist Betty! In any case, yes, you can choose where you want to go - since I live in Northern Balto County - no where near GW or Holy Cross - I checked with GBMC and made a number of phone calls to Kaiser before I got the good word that yes, GBMC is covered and so am I, except for the standard $100 inpatient deductible. Once that was confirmed, I let Betty know and she updated my info, and voila, my lovely referral popped out no more than 14 days after that last office visit, all made out to GBMC. I don't think, however, that they will approve anything but RNY or a band. If you don't specify any particulars to your Nutrionist, they will assign you to a surgeon and a hospital - either GW or Holy Cross - and then you're stuck - getting THAT referral changed after the fact is a tought tough tough row to hoe. I wouldn't try it. If you hear the "80% thing" from your Nutritionist (you'll know what I mean) don't be daunted - keep trying if you prefer a diff hospital or surgeon. If the place you want to go is a Center of Excellence and the hospital itself is a Kaiser-approved facility for other types or surgeries, and the surgeon accepts Kaiser, you have a good shot of getting who and where you want. Kaiser has a lot of rules, but if you play by them it is smooth sailing. For example, that referral I have? It is for the surgery, not just to see someone at GBMC. Kaiser won't leave you hanging - if you 'pass' their program and they approve you - you are approved. End of story. None of the last minute shenanigans other ins companies pull. Good luck to you! Let me know if you have any other questions!
Mare
I just finished the "6 month" Kaiser program on May 22 - although for me it was 10 months because my insane work travel kept me from getting to follow up appointments on any type of regular basis. I ended up taking classes at other centers, saw another Nutritionist once even, but got through it just fine - kudos to my nutrionist Betty! In any case, yes, you can choose where you want to go - since I live in Northern Balto County - no where near GW or Holy Cross - I checked with GBMC and made a number of phone calls to Kaiser before I got the good word that yes, GBMC is covered and so am I, except for the standard $100 inpatient deductible. Once that was confirmed, I let Betty know and she updated my info, and voila, my lovely referral popped out no more than 14 days after that last office visit, all made out to GBMC. I don't think, however, that they will approve anything but RNY or a band. If you don't specify any particulars to your Nutrionist, they will assign you to a surgeon and a hospital - either GW or Holy Cross - and then you're stuck - getting THAT referral changed after the fact is a tought tough tough row to hoe. I wouldn't try it. If you hear the "80% thing" from your Nutritionist (you'll know what I mean) don't be daunted - keep trying if you prefer a diff hospital or surgeon. If the place you want to go is a Center of Excellence and the hospital itself is a Kaiser-approved facility for other types or surgeries, and the surgeon accepts Kaiser, you have a good shot of getting who and where you want. Kaiser has a lot of rules, but if you play by them it is smooth sailing. For example, that referral I have? It is for the surgery, not just to see someone at GBMC. Kaiser won't leave you hanging - if you 'pass' their program and they approve you - you are approved. End of story. None of the last minute shenanigans other ins companies pull. Good luck to you! Let me know if you have any other questions!
Mare
When someone says "My heart needs lifting..."
Don't ask "How come?", ask "How high?"
Don't ask "How come?", ask "How high?"
Hi Mare,
Congrats on your approval! I wish you the best.
Thank you for the information. I had heard some people say that they make you go to a surgeon that they approve. I really want the DS rather than the RNY because after the DS you have less chances of ulcers and they can actually use that little scope thing to check out your stomach if you are having problems.... plus you can take advil afterwards.... I always have little aches and pains so I need advil... hehe. :-)
I know there have been some people in CA who have gotten Kaiser to approve the DS after appeals. But I do not know how the appeals process works here in Maryland. Plus I am afraid that if I raise too much of a "stink" they'll just say no to it all. I don't think they can actually do that, but I worry about everything. :-)
Does the nutrionist make you loose 10% of your weight ?
Thanks again!
Lori
Congrats on your approval! I wish you the best.
Thank you for the information. I had heard some people say that they make you go to a surgeon that they approve. I really want the DS rather than the RNY because after the DS you have less chances of ulcers and they can actually use that little scope thing to check out your stomach if you are having problems.... plus you can take advil afterwards.... I always have little aches and pains so I need advil... hehe. :-)
I know there have been some people in CA who have gotten Kaiser to approve the DS after appeals. But I do not know how the appeals process works here in Maryland. Plus I am afraid that if I raise too much of a "stink" they'll just say no to it all. I don't think they can actually do that, but I worry about everything. :-)
Does the nutrionist make you loose 10% of your weight ?
Thanks again!
Lori
I reject your reality and substitute my own!
Hi Lori,
The surgeon you go to needs to accept Kaiser insurance, and like I said, the hospital needs to be on the Kaiser list of affiliated hospitals. Sorry I do not know anything about the appeal process in Maryland - I haven't had to ever appeal anything. I would discuss the DS with your nutrionist - mine was a wealth of information about a lot of things, not just nutrition! As for losing weight during the Kaiser process, you should have been given a goal at your first follow up meeting - after the GB I class. Mine was 9 lbs and I blew that away, losing just shy of 20lbs - and trust me, neither 9 lbs nor 20 lbs were even near 10% of my beginning weight! Neither she nor anyone at Kaiser ever mentioned needing to lose 10% of your body weight.
Again, best of luck to you, and keep us posted! If I can answer any questions, please send them my way!
Mare
The surgeon you go to needs to accept Kaiser insurance, and like I said, the hospital needs to be on the Kaiser list of affiliated hospitals. Sorry I do not know anything about the appeal process in Maryland - I haven't had to ever appeal anything. I would discuss the DS with your nutrionist - mine was a wealth of information about a lot of things, not just nutrition! As for losing weight during the Kaiser process, you should have been given a goal at your first follow up meeting - after the GB I class. Mine was 9 lbs and I blew that away, losing just shy of 20lbs - and trust me, neither 9 lbs nor 20 lbs were even near 10% of my beginning weight! Neither she nor anyone at Kaiser ever mentioned needing to lose 10% of your body weight.
Again, best of luck to you, and keep us posted! If I can answer any questions, please send them my way!
Mare
When someone says "My heart needs lifting..."
Don't ask "How come?", ask "How high?"
Don't ask "How come?", ask "How high?"
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