DS and Kaiser (Southern CA)

Sher Bear Mama
on 6/25/11 5:35 am
Hi. I'm new here and hoping to find anyone who has any experience with Kaiser (of So Cal) and the DS. I am in the process of beginning the Options program--their mandated classes and weight loss program prior to scheduling the surgery. I would like to know if anyone here has had the DS through Kaiser and what their experience was like. I was thinking about bypassing the Options program and going straight to the surgeon (which makes me automatically bypass the classes and I go back to the back of the line) so that I can get a possible rejection. Once I get the rejection I'll file the first grievance. But I wondered if I need to go that far. Perhaps I can just take the classes and get the DS!

If anyone here has experience with Kaiser (preferably recent experience) please respond!

Sheri
larra
on 6/25/11 6:58 am - bay area, CA
Kaiser SoCal does have a surgeon who occasionally does the DS when the patient insists on it. So he doesn't do many, but he is an experienced bariatric surgeon with a good reputation. His name is Dr. Belzberg, and he's at Kaiser in Harbor City.
      The Options classes will have no info on the DS and will be useless for you. You could attend them if you like, OR you could put in a request for the DS now and request to see Dr. Belzberg. You may need to file a grievance. But if you know your stuff about the DS and stick to your guns, you can get there.
      We do have a couple people here who had their DS with Dr. Belzberg, and a think Bookfaerie was the most recent one, you could do a shout out to her. She did a great job navigating the system.
     
Larra
Sher Bear Mama
on 6/25/11 9:57 am
Larra, thanks for the help as well. I'm going to follow all of your advice and I'm sure I'll get where I want (need) to be. I've been reading the dsfacts.com website and it's been helpful as well. Hopefully I'll hear from Bookfaerie soon.

:-)
Sheri
Samaro ..
on 6/25/11 7:10 am, edited 6/25/11 7:10 am
As Larra mentioned, Bookfaerie had her DS by Dr. Belzburg just a few months ago.  I sent her a notice that you are looking for feedback.  Hopefully she is around this weekend and can get by here to help.





Sher Bear Mama
on 6/25/11 9:55 am
Thank you Samaro for sending the notice out to Bookfaerie. It'll be great hearing from somone with recent experience. See below (my other response) to see what I found out on Friday. I do appreciate you help so much! I'll stay strong with this and fight it.

Sheri
(deactivated member)
on 6/25/11 7:22 am - San Jose, CA
I want to make sure you understand a couple of things you may already know, but it's important that you do:

Belzberg is capable of doing the DS; however, KAISER SAYS THEY DON'T OFFER THE DS.  As far as I know, the only people who have gotten a DS from him had to demand it, go through then entire internal appeal process (pointless, since they are NOT going to say yes) and only after exhausting their internal appeals (takes several weeks, probably at least 2 months), then they have the right to appeal to the DMHC for an IMR (indpendent medical review) which usually takes 45 days or so AFTER you submit your complete appeal.

And here's the other problem - you need to have a consult with a "real" (outside Kaiser) DS surgeon who will write a letter of medical necessity (LOMN) to have the best chance on appeal.   Which means you have to jump through some additional hoops that are particularly time wasting and annoying - AFTER (and not before!) your first denial of a request to for a DS, you will have to make an appointment to see either Crookes or Keshishian (I STRONGLY suggest Keshishian, because you can get in to see him more quickly and he is more pro-DS) and SELF PAY for a consult with him.  But, when you win the IMR, you can get reimbursed for the consult, because you got the denial first.

Still, that's a bummer on several levels - besides your money out of pocket, Dr. K knows he's not going to be the one to do the surgery, because if you win the IMR, Belzberg will do it anyway.  And $300 or so he gets to see you and write you a LOMN when he is not going to get your surgical fee anyway is not in any way a good deal for him.

As for the Options classes, you can get out of them by calling the DMHC and filing a grievance, asking for a waiver from the classes, and citing this document: http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf
Sher Bear Mama
on 6/25/11 9:52 am
I actually called Kaiser on Friday and they read a list off to me of the types of bariatric surgery they offer and the DS was included! Now, perhaps they included it because they HAVE to since they technically have a surgeon who offers the procedure.
 
DianaCox, am I understanding you correctly that I can (and will be successfull) file a grievance with the DMHC NOW--before the classes start--to get them to make Kaiser wave the classes? I was scheduled to go the orientation next Friday--perhaps I should go and just see if there are any changes. BUt in any case, I'd be willing to file the grievance with the DMHC first if it means getting the ball rolling.  In fact, I can file the grievance online today if you think it's a good idea. I definitely don't want to attend classes if they're about the RNY and not the DS. What a waste of time that would be.

Also, Kaiser then gives me the option to meet directly with the surgeon within a couple of weeks if I deny classes (and perhaps in the mean time get the letter from Dr. Keshishian)--should I meet with him and let him turn me down for the DS? I've been told I'll get a definite regection based soley on the fact that I didn't take the classes. So, do you recommend my meeting with him (Belzberg) ASAP anyway or should I wait until I see a private surgeon?

Can you tell me where Keshishian is located? Oh, I think you have a links page here on the message board, don't you? Also, do you think I might have success with another local surgeon who would write the letter? Or should I just not waste time and go straight to keshishian? I do hate to waste his time but I really do need the DS so I'll be selfish here.  

Please let me know as soon as possible so I can get the grievance going.
Thanks so much! 
Sher Bear Mama
on 6/25/11 10:09 am
Just looked at the surgeon directory and saw that the nearest surgeon listed is in Santa Barbara--David Thoman. I wanted to mention that I live in Eastern Ventura County --about 30 miles from the Woodland Hills facility.
(deactivated member)
on 6/25/11 10:12 am - San Jose, CA
DO NOT GO BY THE OH DIRECTORY - IT IS WORTHLESS.  SURGEONS LIE.  The only list to use is the one at DSFacts.com.
Sher Bear Mama
on 6/25/11 10:58 am
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