IMR in Oregon?

Did anyone here need to use an IMR...specifically for Kaiser? I am beginning my research on starting the fight with Kaiser to get my DS so I am wondering if anyone here has any suggestions they can lend.

Background...I started with Kaiser in June of 07 in their bariatric program. Jumped through a ton of hoops and continue to do so since they don't condone the DS (Dummy me for bringing it up  in conversation with the nurse). They have found a menagerie of things for me to do to prolong this process and make it a nightmare for me to even be approved for anything. I have no co-morbidities but my BMI is high enough that I qualify for a DS (in most programs) without them. Im not a hater on any surgery...I just know what I want for myself.

Any help?

Define IMR? 

I know for sure that none of the Oregon Kaiser WL surgeons performs the DS.  However, OHSU is the only one that performs DS in Portland.

Otherwise, I have no clue what IMR is.

IMR = Independent Medical Review

I know that Kaiser doesn't do the DS or even speak of the DS. Dr. Deveney at OHSU would obviously be my ideal surgeon since he is so close.

I just need the Independent Medical Review to look into the denial that I will be getting from Kaiser. Ill just keep on looking though :)

I think IMR is applicable only to those who live in California.  Complainants usually have to file for an IMR thru the Department of Managed Health Care (DMHC) in California.

If you're denied for DS by Kaiser, then file a formal complaint with the Oregon Insurance Division.  Here is the link:  "Filing a Complaint"

Hope this helps!

What is IMR?  I had RNY thru Kaiser 2 yrs ago.  They do not do the DS.  RNY is the only surgery they do.  I know for a fact they may be considering the Lap band sometime in the future, but that is all I have heard.  It took me 18 months to jump thru all their hoops, to get from Orientation to the appt with the surgeon.  After that, it was a piece of cake.

Good luck,

Peggy

 Silly me but are you giving someone the finger in that picture?  or is it just distortion???? :)

DS might be difficult if the doctors do not do it.  I don't suppose there is a way to get Kaiser to let you go out of preferred provider (namely them)  for your DS?  Or perhaps travel to another Kaiser hospital where there are doctors who do perform the surgery?

Tina

LOL! Good eye!!! I actually tried to crop that part out of the picture for this site but well I guess I didn't do a good enough job. Just a bit of my personality showing through lol. You are the first one to notice though!

I know its difficult with Kaiser...beyond difficult. I am looking into the Independent Medical Review in order to overturn their denial though. I wi**** was as easy as just going to another Kaiser but they as a whole won't do it, or even discuss doing it. Its the bad word amongst the Kaiser system lol. Ill just keep up my fight until I get it...one way or another :)

Have a great one! :)

I have no words of advise for you, but it sounds like you know what you're doing.  I hope you are successful in your fight!  I personally hate Kaiser (had one too many mistakes by them), but I know that their system can work if you are willing to be your own best advocate and keep on top of everything and make sure you get the care you deserve!  Good luck!

~Melody

Thanks! Im sure ill need all the luck I can get during this process.

Im certainly anxious to get rid of Kaiser but haven't had any luck getting my employer to go elsewhere. If only I wasn't so darn devoted to my company :)

Well enjoying where you work is important!  Luckily my employer offers several choices, I had Kaiser for a couple of years, but now have Blue Cross/Blue Shield.  My insurance doesn't cover the DS either however, so that wouldn't be of help to you.  I'm trying to get the RNY myself.  Keep us posted on how it all turns out! 

~Melody