Kaiser ?

I work for Kaiser in the department that approves the referrals. If you specifically wanted the DS and they denied that request, then you would have a letter outlining the appeal process. There is a board that reviews the appeals and each is done on a case by case basis.

Mare is right, if you really want the DS, you need to ask your nut to submit your case to the gastric bypass committee specifically asking for DS and not roux-en-y or lap band. Then that way, if it's denied, you'll know if it was the DS that was denied or something else denied. and then you can appeal based on that. Kaiser has different types of appeals, but the whole process is always outlined in the denial letter.

There are also different levels of Kaiser insurance...Signature, Select, and 3-tier...Signature is much more restrictive and limits where you can go and who you can see. Select less so, and 3-tier even less so, so you need to know which policy you have. Kaiser is also very selective as to who they have sign on as surgeons, so most likely wherever you'd be approved to go to will have to be a Center of Excellence. Oh, and remember, Susie Q who works for Acme and has Kaiser may have a very different policy from Sally J who works for Business B, so there is no blanket approach to all of this.

Mare is right about the other part too...once you are approved, you are approved and it's pretty smooth sailing fromn that point out. Most of the surgeons have access to the Kaiser system and put in the referrals themselves to make sure they get paid. Usually takes 48-72 hours for them to be approved, but it is nice how everything flows once approved.

Trust me, the worst (the 6 months with the nut and all the other hoops) is over.

Erin

Hi,

I went to my PCP today and he was very nice (I haven't been going to him for that long) and he was surprised at how much I knew about the different surgeries.  I told him that I have been looking at them for about 7 years.  :-)

He agreed to send the referral so I can get into the program.  His office assistant said that I need to choose a hospital program...

I am soooo confused.  Holy Cross looks nice but the do they VSG at GW... (that's the 1st step for the DS)  The only other doctor in MD that does the DS is Schweitzer, but he does it in two steps.... not sure if Kaiser would go for that or not... why two steps I wonder?

Thanks for your help!

I was really pleased with GW. It's a new hospital and the staff there was great. It's a pain to drive into DC and the parking is about $16 a day, but I thought it was well worth it because the care was so good. Not to say Holy Cross isn't good, but I think GW probably has a better ICU, and if something goes wrong, you want to be at the place to best handle that.

Erin

Hi Erin,

I was leaning towards GW because they do the VSG - but I will call Dr. Schweitzer's office on Monday and ask them a few questions as well.

My doctor's assistant said she needs a Dr's name, address and phone number for the referral for me to get in to the program?  Do you know what I should tell them to put on there?

I need to call Kaiser because I do not know about these steps.... once I get the okay to be in the program I need to go to the GB1 class... can I pick anyone I want with any Dr. that takes Kaiser?  Do I get to pick any nutrionist or should I pick one at the Dr./Hosp. I am cosidering?  Do I need referrals for the nutrionist?

Lori

Hi Lori - You do NOT need to choose the hospital or program at the beginning of the 6-month journey with Kaiser.  You can specify it at the end of the program, before your nutritionist submits your package to the GB Review Board.  The referral you get from your PCP is the one that gets you into the GB program - Start with the GB I class, and off you go!  You have at least six months to do more research on hospitals and surgeons, although you will probably hear at the GB I class that Kaiser does surgeries a Holy Cross or GW only.  Not exactly true, but you definitely have fewer options if you want a DS.  If I had HAD to pick between GW and Holy Cross, I would have gone to GW - I think the program there is top-notch and the surgeons are excellent - if you are having RNY or band and are classified as 'high risk' you WILL be assigned to Paul Lin at GW - he handles all the high risk patients, and handles them very well!
Good luck!
Cheerios!!
Mare

Oh, my doctor's assistant told me that I have to have the Dr's name, address and phone number for the referral?  I'll have to find out what they should put on there.

Thanks!

Lori

Hey Lori - you need that info for the final referral - the one the GB Review Committee writes AFTER you go through the 6-month Kaiser program.  If you are just at the beginning,  your PCP doc just writes the referral to the GB program - check again, and call member services if you are not 100% clear - they are pretty good there.  I have Kaiser Select but I don't think the process itself is any different.  My first referral to the program - yikes, was that last July?? - was just to the GB program - no specific doctor was listed, honest!

Good luck!
Mare