Kaiser Coverage - Experience?

Our HR department has confirmed with me that our Kaiser policy does include bariatric surgery as a benefit. I am SO relieved! So, I am going to switch to Kaiser from BCBS during open enrollment effective January 1. My BMI is 51 and I've just been told I have to have my gall bladder removed. I think it might make sense to postpone my gall bladder removal until after the first of the year. Maybe they can do it all at the same time. I want to get the lap-band, so I am hoping it all works out well without too much delay. Anyone else have similar experience? I'd like to hear what your experience has been with Kaiser for lap band. Thanks!

Cheryl: I had surgery on August 22nd thru Kaiser. It does take awhile to get thru their program. They only do the RNY, they do not do the lap band. OHSU is the only one's that I know who do lap band surgery. I also had my gall bladder removed and an umbilical hernea repaired thru Kaiser. Good luck on your journey, Peggy

Thanks, Peggy. That's a bummer if they will only do the RNY. I do not wish to have that surgery, so I guess I am back to my self-pay planning! ugh

Hi Cheryl, That's so funny because I'm just now switching from Kaiser to BCBS because I haven't had luck with Kaiser! The plans can differ based on your employer, so I would ask to see the specific writing in the policy. Mine said it would only cover the bypass. I couldn't get approved, even though my primary care doctor was in support of it. My BMI is 48 and my Kaiser plan requires BMI over 50 unless you have one of their specific co-morbidities (ie: UNCONTROLLED sleep apnea, not just sleep apnea, diabetes that cannot be controlled with medication, not just diabetes, etc.) Hope that helps. Again, I would ask to see what it says in writing in the benefit book to help make your decision. Shondra

Hey Cheryl I am going through the process now. It is a long process. I have been working on this for almost a year. I am drawing closer. It is true Kaiser only does RNY surgery. It is also true they do not do the laparoscopic surgery. It has to be open RNY. You have to loose appx 10% of your total body weight before surgery. For me that was 51 lbs. I have lost 45.5 so I am almost there. I go back for my next visit on 11/18/06 and hope with fingers and toes crossed that I get to move forward for surgery. I actually work for BCBS and my insurance "sucks" for bariatric coverage. That is why I went with my husbands at Kaiser. I wish you luck on your journey. Which ever you choose. Sarah

Thanks Sarah! I was disappointed to learn Kaiser only does open RNY. I have decided to self-pay for the lap band instead. Congrats on your weight loss and best wishes for your surgery!

...so make sure you have lots of change in your pocket when they weigh you for the first time. tee