Question:
What history is required before you can be considered for approval?

I saw my PCP yesterday and he told my I would need to see him for a year and have a record of formal weight-loss programs that I have tried and failed before Kaiser would even consider my case. Are these truly Kaiser requirements or is this road block being put up just by my doctor? My BMI is 57.8 and I have severe hypertension.    — Charles W. (posted on August 9, 2000)

August 9, 2000
Call your insurance company and ask them exactly what the requirements are.
   — Kellie L.

August 9, 2000
Dear Mr. C. Williams...Who is your PCP in Escondido...Do you see Dr. Bill McCarberg or who...I also use Escondido Kaiser and just had my surgery 5 months ago...Also are you a new patient to Kaiser in Escondido...If you will contact me I might be able to help [email protected] is my email address...Pacific Bariactric did my surgery in San Diego, Scripps Mercy Hospital...It only took about 6 weeks for my approval...I also had a friend who just switched from Kaiser in Riverside to Escondido and they sent her paper work in within a month...So let me know who you are seeing and maybe I can help you...Patt
   — Patt C.

August 9, 2000
I have had Kaiser for several years and had a very positive experience getting approval. However I don't know about the criteria for belonging for one year. As far as documentation goes all you need to do for your diet history is list all past attempts. You can include Weight Watchers, any fad diets, Phen-fen....any attempt to lose the weight. I would also insist that my doctor submit for authorization so you can at least get the official denial and then appeal. They wouldn't make you wait a year for other life saving surgery. Best wishes to for fast approval.
   — Cecelia R.

October 4, 2000
I also have Kaiser in So. Cal. Since they contract their gastric bypass cases to Pacific Bariatric, it was recommended that I contact PB and get some info from them. I was told that I need 1) one year min. of Kaiser coverage; 2) BMI of 40 with 2 co-morbidities or BMI over 50 w/no co-morbidities; 3) PCP referral. would suggest you have the Psych eval, Nutrition and co-morbid tests done now while you're waiting for your 1 year anniversary. When the one year comes up, you'll be all done with your other required tests and should be ready to roll! Good luck!
   — careywatkins

October 4, 2000
I too have Kaiser and my PCP is at the Carlsbad office. I had my surgery on 9/28/00. Have you been with Kaiser for longer than a year or are you a totally new member? I don't think that should matter if you your BMI is high enough. You should call the member services department at (800) 464-4000 and ask about the year criteria. You probably need a WLS friendly doctor. Also, right a list of every diet you have ever tried even if they are not doctor supervised. Write a letter about your health and your family history and how weight loss is effecting your life. Give a copy to your doctor. You can email me for any other info. Best Wishes
   — Cecelia R.

May 1, 2001
HI, I HAVE BEEN WITH KAISER ONLY SINCE OCT. 2000 AND WAS APPROVED FOR RNY @ PACIFIC BARIATRIC IN SAN DIEGO. I WROTE A LETTER BEGGING FOR THE SURGERY AND HAD MY DR. SEND IN ALL THE LAB WORK THEY REQUIRE. MY BMI IS 44 AND I HAVE MANY COMORBIDITES SO MAYBE THATS WHY I GOT APPROVED SO FAST. I HAVE A SITE HERE IF YOU WANT TO CHECK IT OUT. IF YOU HAVE ANY QUESTIONS YOU CAN EMAIL ME FROM THERE. MAYBE YOU HAVE ALREADY HAD THE SURGERY????? TAKE CARE AND MAY GOD BLESS YOU, MRS. MICHELLE BUTCHER
   — MICHELLE B.