Kaiser San Diego Options Program

I am posting this to help assist a few people that have Kaiser. They are told they have to go thru the Options program which is really costly. Their PCP have already given the recommendations and the only part that may be a problem is going thru the options program.

Do anyone know if this is a do or die prior to surgery and if not how or what is the procedure to appeal?

Any and all information is greatly appreciated because these 3 people can not afford the cost of the Options program and are 5'1 and 280 plus lbs!

Thank you

Regions of Kaiser may vary slightly. But, I had Kaiser in southern CA. I had to either participate in the Options program OR participated in a medically supervised wt loss program at least 6 months long within the previous 5 years. I had paid to participatin in a program some 4 years before, and stayed with the program and monitoring for 8 months. I got a letter from the head of that particular wt loss group, and it met with Kaiser's approval.  The members you spoke of may be able to go on a doctor supervised wt loss program of 6 months duration, but then they would have to apply all over again.  I not sure your friends can get around this one.  My support group has told me that new Kaiser preop nutritional classes will have their wt DOCUMENTED when they leave the class. IF THEY GAIN WT between that time and their initial surgeon consult, their surgery will very likely be delayed until they get down to the DOCUMENTED wt from Kaiser. It appears that Kaiser wants people who are determined to make the program work, and that means keep their wt the same or losing a little more until they see the surgeon. My surgeon's office is often called to see what initial wt was noted by the surgeon's office.  This won't take their approval for surgery away from them, but just delays their ability to get the surgeon to do surgery. DAVE

 Regrettably, the best source of information on handling insurance, possible appeals and Kaiser in general, has just received a life long ban.  

 If you go to the new forum, Diana Cox is there and can give you some guidance on how to handle this. 

Go to:  Weight Loss Surgery - Login
weightlosssurgery.proboards.com

You will need to set up an account and it can take a little time to get it going but there's a bunch of us there and Diana can really give you some good advice!!

I had my surgery two years ago and the 6 month supervised weight loss plan is mandatory. There is no appeal. You dont do it, you dont participate. It doesnt have to be a Kaiser options program either (well at least it wasnt then). I had a physical trainer at 24 hr fitness monitor my weight loss, gave me a diet program & excersize plan and the trainer wrote a letter to Kaiser with my progress and that's what qualified me. There are other programs members can use online, ex weigh****chers, etc. Your friends were probably told that they have to go thru Options because they didnt have 6 months supervised weight loss plans done previously.

Hope this helps.
M

It's not true that you have to dot he Options program. You can appeal to the Dept of Managed Health Care and they will make Kaiser waive that requirement.

However, sometimes the appeal process takes as long as going through the program.