Dr. Michael Nowak- comobidities are not "serious" enough???

I have severe Gerd, high cholesterol, low back pain, joint pain, hip & feet paint, shortness of breath, arthritis, heart palpitations, urinary stress incontinence, depression, swelling of the feet, ankles and knees, extremely large breast(F), loud snoring, infertility, irregular menstrual cycles, and excessive sleepiness, yet Dr. Nowak stated to me that I do not qualify because my comobidities are not considered "serious" enough for Kaiser and that the risks of the surgery out weigh it. Has anyone had Dr. Nowak? He seems to be a nice person, but I felt very uneasy with him. You know when something just seems "wrong" and you have that weird feeling? My BMI is 39.9, it pretty much changes on a daily basis from 39- 39.9. Does anyone have any suggestions as to what my options are? Thank you for your help and ideas. Thnaks, Diane

Diane, You definitely have more than enough comorbidities to qualify for the surgery. Click on "your Journey" and go through that step by step. Switch to a pcp and surgeon that understands WLS and the requirements. Kaiser insurance can be contacted directly by you. Ask for their requirements in writing then gather all the paperwork and tests you need to submit for preauthorization. Sample letters are also available under "your journey" Insurance troubles. Good luck and do this for you! Luann

Thanks Luann, I did go to "your Journey" and went through that step by step. Long story short I did switch to a pcp that understands WLS and the requirements and is definately on "my side". I have contacted Kaiser insurance directly and they faxed me requirements for the surgery but they seem vaigue. In other words the comobidities are not listed in detail, it says "etc..." I will call them again and asked for a deatiled expalination of "what qualifies" me for the surgery. Thanks, Diane

Diane, I too, think that your co-morbids should qualify you. Check with St. Vincent's or University Hospital. They both have great programs! Sue

Hi Sue, Thanks for your help!!!! I am currently waiting for a referal to St Vincent's for a second opinion. The #! thing I can not stand about Kaiser is that you need a referal for everything. Our insurance switched to them in Jan 05, our previous insurance co was united health care, boy do I miss them! We never ever needed a referal we just went to see any specialist we wanted/ needed to see. Thanks, Diane

I have Anthem, not Kaiser...BUT my BMI was 39.5, and the only major problem I had was sleep apnea. (Even at that my CPAP only had a setting of 7) My blood pressure is and has always been 115/60, my cholesterol wasn't bad, etc.etc. But my surgery was completed 10 weeks after I first attended the WLS seminar. Have you had a sleep study done for sleep apnea?? The snoring, depression and swelling could all be the result of apnea and it is definitely a comorbidity that can tip the scales with an insurance company. Good luck, Becky 254/204/154 -50 lbs in 8 weeks

Hello Becky! Thanks for replying. I have in fat had a sleep study done about 4 weeks ago. According to the results I do not have sleep apnea, they say I have Hypnoapnea, which mean loud snoring. I was also informed that my breathing slows down considerably however it does not completely stop so therefore it is not considered sleep apnea. It was made very clear to me that if I had the sleep apnea I would have qualified for the surgery. For now I get to wait for the referal to go through to St Vincent's. Hopefully it will not take Kaiser a long time to process this. Thanks for your help, Diane