Question:
Kaiser Requirements
I am getting lap band surgery in about 8 weeks if all goes well. My best friend has Kaiser and went to her PCP to inquire about bariatric surgery and her Dr. told her there's no way Kaiser would approve her because she has no medical problems (co-morbitities) However she does get a rash under her gut and her PCP said if that continued to be a problem, she would refer her for a tummy tuck. !?! Does anyone know what Kaiser requires? Is this just a matter of maybe switching PCP's to someone who is more weight-loss surgery friendly? Her PCP recommended the South Beach Diet. And a tummy tuck just doesn't make any sense to me at all. Any help would be appreciated. She's having trouble being supportive of me because she doesn't want to be "the fat friend" Thanks — Kayla W. (posted on April 6, 2006)
April 6, 2006
There are many PCP's that are not thrilled with recommending a patient for
WLS because it is very costly. Kaiser has some. Let me ask you this.
What is your friends BMI? Why does she want WLS if she does not have any
co-morbidities (i.e. diabetes, hypertension, joint issues, asthma, etc.)
This is not a "diet", this is a lifechange. Has she had
documented UNsuccessful diets before? They will ask her. She needs to
plead her case if she is serious. I am currently enrolled in the Kaiser
Program called Options. It is a lengthy process which requires that you go
to weekly classes for 6 months. The classes are very informative and also
require a 10% weight loss, before surgery will be authorized. Have your
friend research the surgery online if she has access to the internet.
Hopefully, she will make a educated decision to weight loss, this is not a
cure... just a tool. If she feels that this is the route she needs to go,
then maybe a change in PCP is necessary. Also, a friend is someone that is
supportive NO MATTER WHAT! Tell her that this is not a competition and a
TRUE friend wouldn't make it that! Good luck!
— NOODLEMOM
April 6, 2006
Her BMI is about 44. She's 5'2 1/2" and 245 lbs. And that is
considered morbidly obese. If she doesn't have any health problems now, she
will eventually. However she hasn't been tested for any either. I think
they just assume if she's not complaining, she's fine....
— Kayla W.
April 6, 2006
Her doctor can take her through as study, to check if she is indeed a good
candidate for WLS. Co-morbidities, such as failing numerous diets, sleep
apnea, diabetes, hypertension, osteoarthritis, another stuff, means you
need at least three of them plus being 100 pounds over your required weight
for your height. The doctor just should not say no. I have Kaiser too.
— sor09
April 7, 2006
I just moved from California and was moving through Kaiser's baratric
process. I used to live in Northern California--they me go to a short info
session (my pcp had to send a referral). I know that if you have a BMI over
50 they will approve you provided that you go through their "Healthy
Ways" program for six weeks. During the "Healthy Ways" one
can get Phentermine for three months and it is a physican monitored
program. I believe that if you are under a 50 BMI you do have to have one
or more co-morbities. She could always change her PCP anytime she wants
to--I never had a problem with my doctor. A rash won't get your friend
bariatric surgery from Kaiser--they are tough cookies when it comes to
surgery. I was approved because I have a BMI 51.5 with diabetes and joint
problems.
— yakypakrat
April 7, 2006
I just started the process with kaiser and will soon be starting the
options program in panaram city. I know i must lose 10% and take the 24
week program my BMI is 63.6. I had to have 3 co morbities for my dr to
even give me the referrel for the classes. research it and a hint my dad
gave me is tell them what they want to hear. he had the surgery done last
year. i had to finally argue with my dr and after wards he said ok then
lets do this. he wanted to see how serious i was and it worked.
— MichelleDW
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