Dealing with Kaiser

Becky B.
on 9/18/06 1:11 pm - Petaluma, CA
Okay so  here is the deal ... I have been working for a long time to get the RNY and a couple of weeks ago I met some people that had gone and had the DS ... now after researching the DS I am positive that this IS the surgery that would work best for me ... one problem though is I have Kaiser and they have told me that Kaiser does not do the DS.  Has anyone out here had Kaiser and gotten the DS?  If so how do I go about this?  They cover the RNY and I am approved for that but would much rather have the DS ... Im not sure what my next step is .... Thanks for any and all help :)
Xavier Smith
on 9/18/06 3:32 pm - CA
Becky: I am Kaiser plan member.  Although I am going for the Roux-en-y procedure, I was told by my primary care provider that duodenal switch and lapband services will be covered in the near future.  It is my understanding that there are no properly credentialed providers under Kaiser who are able to do it.  I got the impression that it was simply a limitation due to lack of qualified people to do it and less that it's an exclusion in your EOC. One word of advice though:  be very mindful when contacting Kaiser customer support.  If I did not already understand the workings of insurance, their member support department would have really jacked me up and caused me not to be covered in some respects.  Have them mail you a copy of your explanation of coverage so you can look for yourself to see what's covered or not.  Just today, I had to call them on some VERY incorrect and illegal information they gave me about coordination of benefits.
Becky B.
on 9/18/06 4:40 pm - Petaluma, CA
Xavier, Thanks so much for your reply.  I am under the same assumption as you are, but I have been browsing and where it says to locate a physcian I did just that and browsed through to see if anyone had Kaiser and I was able to find a couple of people that were sent to another hospital and Kaiser covered their surgery for lap band and DS.  I guess I will just call and speak to member services and have them send me information as you have said.  Thanks so much again. Becky
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