Question:
Anyone insured by Kaiser? If so anyone have trouble getting approved?

I spoke to someone who had gbp through kaiser two years ago, and I know things have changed since then. I was just wondering if anyone had it recently through Kaiser, and if there was trouble getting approved.    — rm R. (posted on January 1, 2003)

December 31, 2002
I have Kaiser and started the log road to wls on 12/19/02. The 1st thing you need to do is see your PCP. Kaiser now has a worksheet for PCP's to follow that will help them know how to help you. My PCP verified my BMI (the chart she had only went up to 40 and on the worksheet it said I had to be over a 40 BMI. I am at 47.) She then took a brief medical history i.e. past surgeries, co-morbs, possible co-morbs, weight loss history etc.... At that point she told me she would send a referral to the Nutrition Services Department, Psychiatry Department and gave me a form so I could set up my own appointment for a sleep study. She also told me I would need to enroll in a 1-year weight management program but that it did not have to be at Kaiser although she did recommend their program. Well that day I went home and made my sleep study appointment for 02/05/03. That was the 1st appointment they had available. I am on the cancellation list to see if anything sooner pops up. The following day I called Nutrition services to verify that they had my referral and set an appointment for 02/03/03. Again the 1st day available. I them called Psychiatry where I was informed that they did have my referral but that they will not even set an appointment until after they have the report from Nutrition Services. I also set an appointment for "Introduction to Weight Management" which is an orientation Kaiser requires before you are allowed to participate in the weight management program. That is set for 01/07/03. I was shocked I could get in that soon. The one thing I have seen other Kaiser members post is that the weight management program is "recommended" but not required. When I meet with my PCP again on 02/11/03 I am going to present her with a letter detailing my life long battle with my weight, co-morbs and weight loss/gain history. I am hopeing I can convince her to send it in to the approval committee along with all my results from my other appointments without needing to complete the weight management classes. I am still going to start them to show my commitment to the surgery. From all that I have seen and heard Kaiser is a long hard road but if you are dedicated, persistent and at times pushy it gets results. Good Luck!!!!!!!!!!!!!!
   — mlovesh

January 1, 2003
Just like any other insurance company or HMO, the rules for how to get approved through Kaiser can vary from one employer to another and from one state to another. I have seen posts from people who had to go through a 6 month supervised weight reduction program and had other hoops to jump through. Many of these had to wait a year between referral and surgery. I have seen other posts from Kaiser patients who were referred and had surgery within 6 months. Get the details from your employee handbook, which you should be able to get from your employer's HR department. Or call their patient services dept and ask what you have to do.
   — garw

January 1, 2003
Hello, I am now following the guidelines that Kaiser has set up. I believe that these guidelines are for all of Kaiser and not just for my insurance plan. They require that you first of all meet the NIH criteria. After that you need to have a history of weight loss attempts with appropriate exercise for your abilities and they didn't ask for indepth attempts from me, I just stated it to them in my letters. They also want you to have a psychiatric evaluation and be cleared for surgery by the psychiatrist. The biggest part is that they want you to have 6 months of evaluations and consults with their nutritionist. I had thought that they wanted me to try to diet again but that wasn't the case. They want you to go to see the nutritionist because they have found that people do better after their surgeries once they have been "trained" by the nutritionist. I had my first consult this past Monday and she gave me info on the surgery and wants me to keep a journal of food and exercise for at least a week or two for the next time I see her this month. She told me that later sessions will be about eating right after surgery including portions and supplements. I hope this helps....
   — Morna B.

January 1, 2003
Also, I forgot to add that I had to take a "Nutrition for Weight Loss" class provided by Kaiser.
   — Morna B.

January 1, 2003
Other than the 6 month delay this seems like a pretty good way to go about WLS. The classes and working with the nutritionist is their way of knowing that you truly know what you are getting into. I'm sure it will help with dealing with the changes afte surgery. I would be upset about the delay but if I step back and am objective, more insurance companies should take this approach in my opinion.
   — zoedogcbr

January 1, 2003
I was approved through Kaiser in 2 days. I do feel the only reason I was approved that quick was because have out of network benefits. I will have to pay 20% of my surgeon's fee. The hospital was in network so that will be covered. We just got Kaiser as of Dec. 1st and I know if you have to stay in network, their guidelines are very strict. Don't give up, call member services and ask for their explanation of benefits regarding gastric bypass surgery. Get it all in writing. I had Fidelity before that and did not do that and got my letter of medical neccesity from PCP, saw the nutritionis, saw the pyscho and waited 3 months for a consult with surgeon. Then after six months of waiting, we submit for approval and I find out they want a supervised diet for 6 months straight within the last year. I could have been doing that while I was waiting. So frustrating! Get it all in writing and then get cracking on what you need to do. Good Luck. :-)
   — donna B.

January 1, 2003
I live in the DC area and have Kaiser Mid-Atlantic...while they requrire a lot of testing and hoop jumping, it doesn't seem to be too much more than other ins. cos. All in all, it took me about three months from the time I made the decision to have WLS until I actually had it done. All I can say though, is that I am glad I don't have Kaiser in one of the Western states, like CA or CO. I would NOT have had the patience to do all the nutritional counseling classes, etc. I think making people wait so long to find out if they are even approved or not borders on cruel...
   — rebeccamayhew

January 4, 2003
I went to Kaiser 3 years ago and was turned down flat (5'4" - 292 lbs), my only co-morbid was osteo-arthritis in the knees. They asked me to try Optifast, which I did and failed. then in late summer this year (August-September) I tried again. My PCP didn't like the risks, but I wrote him a letter telling him about my struggles/Optifast/desire to go the surgery route and needed his support or help to find a more sympathetic PCP. He supported me, was approved in less than a month. They did tell me though that in San Diego, they were now approving differently than my first try and I was the first one to be sent to LA for the approval process. I have found Kaiser is taking a more liberal stance on GB, but since my surgery have heard that they are making everyone first go through the Positive Choice center (their weight loss program - Optifast). I also think each state/location is different - but, I refused to give up, Good Luck to you!
   — Bonnie S.