Kaiser Timeline

This is my first official post on this site so please bear wtih me .  I am curious of the timeline and steps that everyone else has taken giong through Kaiser.  My primary care physician has myself and husband going through the 8 week obesiety class before he will give us a referral to the surgon.  We are halfway through the class so I sent him an e-mail asking if we can get the referral now to schedule our appointment and get ahead of the game.  He replied that he can not refer us until after the class and that the "fail" the class.  I don't understand.  What is considered a "fail"?  I'm going to continue to follow the instructors adice in class.  The point is to lose weight, correct?  There are a few other people in this class that have already received their surgon referral.  Is my doctor doing things backwards???  Any advice will be much appreciated!

Sorry I don't know much about the kaiser restrictions, but wanted to welcome you to the OH board. the only info I had on Kaiser is that they denied my friend because she didn't have enough co-morbidities. Taking an obesity class may be a complication. If you comply, and follow instructions, you will likely lose weight. If you lose weight, your PCP may (stupidly) say 'see, you can diet and lose weight. No surgery needed" On the other hand, be may say, yes you are compliant, and follow instructions so you are a good candidate for surgery. Who knows. Some PCP's resist the surgical approach, hope yours is not like that, or you may have trouble getting a referral and approval.

Hang in there, and good luck. And should you encounter resistance, file appeals!!!

Thank you for your reply.  This process has been confusing so far.  The other people in our class have already received their referral to the surgon, gone through orientation and now are doing the class.  I feel like he has me and my husband doing it backwards.  Thought I would find more informaton on these boards but I've been unsuccessful so far.  I'll keep looking!

I have found that each Kaiser offices are different. The Kaiser in Lancaster, CA would not send the refferal until you see the Metabolic Dr. at the end of the Options Classes. The only thing I could speed up is the blood work up, ekg , Phyc eval. These need to be done before your last visit with the Dr. This could be different where you are. Kaiser is pretty ridget with their proceedures. I figure by the time I have surgery it will be almost a year .

Hi there,
Did you ever find out about this?  Not sure why your PCP would not do the referral.  But they do have to have a certain amount of criteria on each patient before they can do a referral.  Maybe the others in the class who already have theirs have more comorbities. 

I am on Kaiser but ended up going outside the system just cuz I wanted a different type of surgery that the kaiser in Oregon does not do.

But my PCP put through the referral so I could make the best decision for myself.  To qualify for the referral, I had to demonstrate I'd been severly obese for a certain amount of time (5 years or 10 years - can't remember), how high my bmi was, then had to document all the ways I'd tried to lose weight in the past,  and then had to look at what comorbities I had (side-effects of my obesity).  You have to have a minimum combination of all of this before they're allowed to submit that referral.   For you and your hubby, maye this class was needed because you were low on something else.  Hard to say.  It's kind of odd... and obese person trying hard to lose weight before they end up with health problems has a hard time getting surgery covered. For me, I had sleep apnea, arthritis in both ankles, and arthritis in my knees.  I think she also checked off low back pain because I'd had p/t for my back before.  It's gotta be stuff that is documented in your record over time cuz they're going to look for backup. 

Once you get the referral, you'll get a call or letter from the bariatric coordinator.  Forgot her name, but a really nice lady.  I think it's done in a letter now.  She'll have a date and time for you to attend a class.  The classes are only once or twice a month.  It goes over the type of surgery they do there (RNY gastric bypass), their program, and the steps of the program.  Usually their dietician is there, one of the counselors, and one of the surgeons.  Their program is becoming more and more reputable and they have a great surgical team now.  Once you go through the class, they set you up to meet with the dietician & the counselor.  Those two may want you to come back a few times before they'll give the green light for you to meet with the surgeon.  After you meet with the surgeon, the bariatric team gets together to review your file and deterime if you qualify for surgery.  The process takes approximately 6 to 9 mos (similar to most other insurance company processes). 

It sounds like a long time, but the last two or three months of it flys by.  I know quite a few people who have had their surgeries through the Kaiser Oregon program.  They are doing just awesome.  Good luck on your journey!

Thank you for your response Ambelina.  I've come to terms and believe that our doctor is putting us through this class first because we are new patients for him.  We switched our insurance this year to Kaiser to go through their Gastric Bypass program.  This Thursday will be our final call.  I plan to send my doctor an e-mail to find out what he would like for us to do next.  I don't mean to come off as pushy but this isn't something that we've decided to do overnight, we've been researching this for the past several years.  Both my husand and myself have struggled with our weight our entire life.  Being skinny and looking good in clothes will be a plus but we need this for our health.  We've come to terms that we both need this tool to help us lose the weight.  Ok, I'm rambling at this point.  Thank you again for the information!

Hi there, my name is Peggy Blazer and I also have Kaiser.  It took me exactly 18 months to get from orientation to surgery.  I had my surgery on August 22, 2006 I started out at 527 lbs, the 1st time I talked to my Dr, she put me on xenical which is a medication  blocks fat absorbtion. I lost over 100 lbs before surgery by changing my diet and exercise. I am down 270 lbs right now,  I go in every 6 months to have bariatric labs done, my most recent visit my dr told me that my diabetes is in "remission" which is good my a1c is 5.4.

Who may i ask is your primary care physician?  Is it thru Sunnybrook/?  I'm just curious.  Do not get discouraged, it does take time, I thought my appt would never come, now that it is over, I would do it again if i had the chance.  I have basically hit the brick wall on loosing, but i am doing what i can to keep on loosing.  Feel free to write to me anytime , my e-mail address is [email protected].

Good luck on your journey

There are no short cuts in the Kaiser system.... be patient because the journey you are about to take is wonderful. I'll tell ya straight up... I had the surgery May of 2011... I have never regretted the surgery... I have regretted not paying enough attention to the classed and taking notes. What you are learning there is going to really help down line.  I'm still on my trek downward and have hit a plateau...It took about a year to get a surgery date. They want to make sure that you really are dedicated to the crusade. They tell you this up front... The surgery is not a cure all... It still requires your undivided participation in your own weight loss. It is a tool that you use towards that end and a great tool it is.  If you had problems with eating it because it is in front of you, not wanting to waste it and taking that one extra bite then  this tool acts as a reminder of when you feel full.  The issues that you will face are still there... staying away from fats and carbs and focusing on Proteins and healthier foods. You will find generally that your desire for those foods you loved are minimalized if not gone.  Things just taste different and you'll adapt to it. LOL you won't like Pasta and heavy breads which eliminates a lot of Carbs and that for me was half the battle.  Like wise sweets will not be such a temptation... at least they weren't for me. There are two things that will help you... listening intently and patience. The rewards of being able to walk into a store and actually purchasing a normal size will be your reward.