Why fight the system--so upset right now

I have been fighting with Kaiser to wave their Options program (should be called No Options program) and have thus far been unsuccessful. I have had a formal Independent Medical Review (IMR) request that's going through the Department of Managed Health Care (DMHC). My caseworker tried to persuade kaiser to change their minds and wave the classes since the nurse there admited that they have nothing to do with the DS and have nothing to offer me but nutritional advice--(that is all WRONG).  So, Kaiser said that since my doctor ordered the classes they asked other doctors for their opions on this. They all said they wouldn't go against me doctor's orders.  Now, I'm figuring the physicians who do the review may feel the same way.

The nurse who teaches the classes was clearly prejudiced against the DS--claiming that it will Kill me at worse and make me very sick at best. I'm so sad that I might have to go through this 12 week program with her. I'm sad and I'm dissapointed.  My caseworker didn't sound opptomistic about the IMR. I cited many cases where the IMR went against Kaiser but I'm not sure it'll be of any help. Now, kaiser won't let me start classes until September. It just sucks.

Not really asking for adivce (though if you have any, I'm open to it)...I'm just venting.

Yeah... No advice.  But I do have something else...

 

im gonna hug you Graphic & Myspace Graphics

Thanks for the hugs. I know I'm a big baby.

Just try to relax. You're most likely going to win your IMR. Even if you don't, it's only a couple of months. I had surgeons at Kaiser telling me all about how terrible the DS was when I had a bowel obstruction. When I told Dr. Belzberg about it, he just rolled his eyes at how ignorant those surgeons were.

Thanks Dana. I am trying to relax but it's tough. If you could have only heard this conversation with the Kaiser nurse educator you'd understand why I don't want to be in her class.  She actually told me she was "appealing to me as a mother" that I not have this surgery. She said I have to think of my CHILDREN. OMG, how inappropriate. I am filing a complaint with the CA nursing board. 

So if you take the classes they'll approve the surgery?

That's the good news, Jennifer.  I've already been approved for the DS. That's a done deal. The only thing in my way is the classes (and mandatory weight loss). I'm thankful that that battle is over a least.

Awesome that you've been approved! I'd just go to classes and spend the time in my "happy place" : )

I know it sucks and you want your DS to have been yesterday, but you will be having it soon. I had to fight to be approved for the DS, and between the internal Kaiser appeals and the IMR, it took me more than the time the Option class will take you. That's not even counting the time to get into the Bariatric program and scheduled for the orientation to even begin the process that most people go through. If I'm remembering correctly, Kaiser usually takes about a year for a person to go through the Northern CA Bariatrics program from referral to 'approved' surgery. (i.e. lap band, RNY, or VSG.)
Hang in there. Your time will be coming soon!
Kim

P.S. - you can actually appeal the 10% weight loss requirement through the DMHC as well. You might want to start working on that appeal asap and have it ready to go.
And as Jennifer D. pointed out, you have to attend the classes, not participate in them. Bring along your iPod and just tune the snotty nurse out during the class times, since I'm betting any nutritional info will be directed at a low-fat, high carb eating style that you will NOT want to follow post-DS.

Along with my internal grievance and the DMHC IMR request, I included the 10% weight loss requirement.  Of course Kaiser denied me that as well--so again, it's up to the IMR.  I'm just not feeling good about this--I think that the way Kaiser has worded their response will not look good for me in the IMR.  They're saying that the DOCTOR is recomending these things.  So IMO, it may happen that the physicians on the IMR board may not want to go against a doctor's orders.  We'll see.

The way the So Cal Kaiser bariatrics works is this: I called in May to get into the program.  The next orientation was June 29th.  Classes started July 22.  The classes are 12 weeks--once a week. I was told the entire process would take approx 3-6 months or even up to a year depending on the wait (and there was none at the time).  Since I've already seen my surgeon, all I need is to have the Options classes finished so that I can make my preop appointment. He gave me the internal number so that I can get in there quickly. So, realistically, I'm probably looking at surgery sometime between December and February.

Now, the info I was given at the orientation for Options was that we had to attend classes and do homework.  Did you take the classes? If so, do you recall what it was like? I'd love to just bring a book and tune out but I'm afraid then the teacher won't "graduate" me out of the program when it's over. 

Oh, and fortunately, I didn't have to fight to get the DS. the Options teacher/nurse/***** said it wasn't an option and that it wasn't even done anymore (She was confusing it with the JIB). But I went to the surgeon armed with Bookfaerie who'd had the surgery by him and brought a welth of knowledge and he approved quickly. So at least that wasn't an issue.