rejected by kaiser after losing 10%?!?!

posting this for a friend whose mother just found out that she would NOT be having her weight loss surgery covered by her insurance (kaiser)
She was told she had to lose 10% of her excess weight in order to get surgery and was accepted into their 24 wk program and she managed to lose the weight she was told she would need to lose during this period.
She finally finished the classes and shorty after received a letter from kaiser stating that she did not qualify AFTER losing the 10% they asked her to lose.
this just doesnt seem right at all!!! Does anyone have kaiser or know of anyone who has experienced something similar?!
Any direction that i could pass along to this very worthy yet discouraged woman would be greatly appreciated!!!!!!!!!!

thanks in advance!

I was afraid the same thing would happen to me. If I lost the ten %, I would not weigh enough to qualify. Besides, I couldn't lose the weight to begin with. Does she have health problems, co-morbidities? If so, I would suggest that she begin the grievance process with Kaiser and then the Dept of Managed Health Center of CA. I did this to request the DS surgery and won my case. She will need to write a formal letter to Kaiser appealing their decision. It will be reviewed locally and then at the main level. If she is denied formally by Kaiser after the appeal, she can go to the DMHC. PM me if  she is interested in more information.

 That's totally BS. They are suppose to go by her start weight. That's why those "medically supervised diets" suck. They use it as a stall tactic to make people give up, and then the ones who do what they want they use it as a reason for not qualifing for surgery. Your friend needs to contact the DMHC (Dept of Managed Health Care) and file a grievance against Kaiser. If she meets NIH criteria for WLS then they have to approve it for her. There's info on my page that might be useful. Best of luck

thank you both so much for the info, i will see her son tonight and gladly pass along the info!!

Im going to have to get her to join OH asap =)

She needs to go to the CA Dept. of Managed Health Care site and follow the instructions for filing a grievance against Kaiser.  I think it can even be done over the phone.

Kaiser has NO RIGHT to require weigh loss pre-surgery -- see this, and have her reference it in filing her grievance: http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf

And I would argue that it is the PRE-DIET weigh-in that counts.

Wow, isn't that a dirty trick.  I had a similar concern, that losing 10% would put me under the BMI requirement.  My surgeon said they ALWAYS go by 'start weight.'  I agree, she should contact the Insurance division in her state.  THat is VERY deceptive. 

Wishing her the best.