DS approved! But...

Sher Bear Mama
on 7/22/11 9:09 am
I just called the DMHC again and the twit that I spoke with didn't know ANYTHING. She was so confused that I think she may have broken some blood vessels trying to understand my case.  Ultimately she said that the case was under medical review because they needed medical professionals to make this decision.  I couldn't seem to get my file out of the IMR process because it has yet to be assigned to a caseworker. 

Then, I called again. The person I spoke with this time said I had requested a "bypass".  Nowhere on my file did I type the words "bypass".  So I very carefully explained to him that I want the DMHC to understand that i only want them to wave the classes.  This is a procedural issue and no medical review should be necessary.  I reminded him that this sort of case had been reviewed many times in the past.  He said they were waiting on info from Kaiser regarding my grievance before assigning my file to a case manager.  He said that he recorded my notes regarding my specific desires and that it should be assigned to a case manager by Tuesday--at that time I can find out what sort of review the file will be under.  I told him that the form I filled out said, "Complain Form" not IMR request.  He said he had it up on the screen as IMR request. But the form sits in front of me on my desk and clearly says Complaint.  Regardless, I'm beginning to think that the DMHC's customer service department is completely clueless.

More info on Tuesday I guess.

Sheri
Sher--the bear mama

  
(deactivated member)
on 7/22/11 9:58 am - San Jose, CA
If you don't get satisfaction on Tuesday, I might be able to help - I have inside contacts at the DMHC.
Sher Bear Mama
on 7/22/11 10:17 am

Will do. Thanks Diana.

Sheri

Sher--the bear mama

  
Sher Bear Mama
on 7/22/11 8:20 am
Just spoke with DMHC and they said that a decision won't be made regarding my IMR for waving the Options Classes until after August 15th.  That was when my grievance was filed. So I have about another month's wait to learn my fate.

S
Sher--the bear mama

  
a_new_mii
on 7/22/11 8:29 am - AZ
   
Join us here weightlosssurgery.proboards.com/index.cgi ~~❁~Ginger~~~
The beginning of a whole new world.              
HW-445
   SW-417    CW-162  GW-175            
  
danas
on 7/22/11 9:34 am - CA
Holy crap!! Congrats! I'm so happy for you! I can't believe Belzberg went along without a fight, that is amazing!!
Won against big bad (SoCal) Kaiser for a Duodenal Switch  Haven't heard of DS? Kaiser wants it that way. Come on over & read the truth
Hit goal (Normal BMI) on 2-10-11!    I LOVE my DS!!
My approval process timeline:
02/12/09 - Dr. refused to refer me for WLS
03/03/09 - Vented/whined about it on another board, planned to just wait until next year & switch plans
Let's see what happens!  **updates in blog**
Julie R.
on 7/22/11 9:48 am - Ludington, MI
 Wow - I'll keep my fingers crossed.  You're one tough cookie.
Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

bookfaerie
on 7/22/11 10:21 am
Sheri and I were shocked that basically within ten minutes he said sure I will do your surgery then we spent the rest of the time just visiting. He was really sweet and rather surprisingly candid about what he felt he could and couldn't do as part of being a kaiser physician. It was really great because sheri got to meet him as the fantastic surgeon I knew without any of the deterring sterness I had at our initial meeting. And really he seems to be softening his stance on the ds entirely.
 "Mediocrity knows nothing higher than itself, but talent instantly recognizes genius." Sir Arthur Conan Doyle

"What your heart thinks is great, is great. The soul's emphasis is always right." Ralph Waldo Emerson    
larra
on 7/22/11 10:26 am - bay area, CA
Sheri, great job! You knew your stuff and it showed.
     Regarding the Options thing, keep on with the DMHC, hopefully with just one person who is in charge of your case. We've seen this before, where someone clearly files an IMR and someone at the DMHC converts it to a complaint, and now vice versa. This can, and should, be handled a lot quicker as a complaint, so don't just let it slide, and get Diana's help if you need it.
      But I'm just so happy for you!

Larra
Sher Bear Mama
on 7/22/11 10:37 am
Thanks Larra. I'll keep on it--and if I don't get help Tuesday, I'll PM Diana. Let's hope it helps! In the meanwhile, I intend to stir up some trouble in those Options classes. If I have to go, I'll at least have to entertain myself.

Sheri
Sher--the bear mama

  
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