Denial

Hi. My pcp sent a referral for bariatric care/surgery, and in 2 days I had a letter of denial saying my coverage absolutely did not cover it. I have been researching, and I cant find anything that says that. Kaiser said that because we are members through a small business group, we were li mited. Now, my pcp's nurse said that it was denied because the bariatric surgeon determined I didnt qualify. She said that's how it always works. How could he have done that so fast? the letter didnt say that. Also I think I definately qualify. Im 5,8 372lbs, and bmi 58, I have sleepapnea, GERD, hi bp. some body help!!!

Hi judy, Girl, hang in there. fight like hell. eventually it will come through. I'm confused about what you wrote that said your *bariatric surgeon determined you didn't qualify*.. what??? 372#'s no matter what other health problems you have should qualify in any bariatric surgeons view point... I have always hated kaiser. Havn't had it since I was 13 but the way they treated me for hidradenitis suppurativa at the age of 13 was an ever lasting memory that will haunt and torture me for life. I notice you are posting from vancouver wa... that's home to me. I am currently in bradenton florida and have been gone almost 6 years. I have a moved back date of aug 5th... I will be writing my own post about support groups. I had my surgery on 4-16-03. good luck and anytime you wanna vent or chat just email me. Theresa

Judy Don't give up! Call Your PCP back. I am a Kaiser member also, hate it! I have heard that if you do what they say to and jump through their hoops you get excellent care. My group is small too and it is covered if medically necessary. It took them three weeks to denied me. My letter also stated that if my BMI is above 50 I would cosidered period. Good luck and keep up the fight! Denise