Question:
CAN ANYONE GIVE ME THE NAME OF A WLS FRINDLY DOCTOR FROM KAISER?

MY SENT IN A REFERAL AND IT WAS DENIED BUT NOW IS NO LONGER INTERESTED IN TRYING TO HELP ME GET AN APPEAL.    — MARIE R. (posted on October 4, 2000)

October 4, 2000
Hi! I also have Kaiser though in VA. Here's what I've found out. Though I have a BMI of 41 I was denied because I didn't meet "guidelines" which said BMI > 35 with 1 of these 3 comorbidities - diabetes, previous joint replacement, or high blood pressure that is uncontrollable with medidcation. I could have had BMI = 60 and that would be their answer. I asked for a copy of the guidelines, they were reluctant but I said I wanted to appeal and they had to give them to me. Anyway, this document was marked "draft" and had a disclamer at the end that said it was not to supersede a physician's opinion. When I talked to customer service they said appeals are often successful but usually take in the 1 year range. He said that Kaiser uses this to weed out patients who aren't really committed to the surgery. Luckily, I have their added choice point of service plan ( an upgrade) that lets me go out of network, with a max out of pocket of $2500. Kaiser contracts Health International to determine medical necessity for out of network and it took about a month for them to precertify me. My date is Oct. 24 for an open (3 1/2" incision) RNY. Hopefully you can find a way to get around them too. One more idea. Go to "find a surgeon" on this web site and look at the different surgeons in your area that have done surgeries with Kaiser insurance and contact the patients directly through their email address. Since the last 300 questions feature is being updates on this website, not many people might see your question right now. Good luck
   — Marilyn M.