Question:
has anyone dealt with kaiser permanente?
I'm looking for anyone who has had wls thru kaiser permanente. I would like to hear of your experience. — suzan R. (posted on March 3, 2002)
March 2, 2002
Kaiser-Permanente is just like other insurance in this respect. It depends
on where you live. I've seen a lot of Kaiser patients who have had to go
through quite a bit to get the surgery and others who have not. If you
tell us where you live, that might help someone who also lives there and
has Kaiser to tell you what you have to do.
— garw
March 2, 2002
Hello. I too have KP (Mid-Atlantic) and am in the process of getting
approval for my WLS scheduled 4/4...so although I haven't had WLS thru them
yet, I can tell you what I've seen...KP seems to be very difficult about
WLS in some areas, especially California. In my research on this site,
I've seen where it can take years to go thru all the testing, nutritional
classes, etc. etc. In my area (MD/DC/VA) it doesn't seem quite as
stringent, but not as easy as some ins cos. (BC/BS, for example.) I have
the PPO Select and am going with a doc out of network; if I had an HMO I
think it would be a much longer, more arduous process, so it's worth the 4k
I will probably end up spending out of pocket. So far I have had to get my
blood gasses tested, a puminoligist (sp?) test, an echo cardiogram, and go
to a sleep apnea consultation (now, these are part of my pre op testing so
I have been killing several birds with one stone). This week I will go in
for a phsychiatrist consultation, and will have to do an at hope sleep
study, which hopefully won't show I have sleep apnea because that's a whole
other can of worms! After that I will meet with a PCP who will (hopefully)
clear me for surgery and sign a form letter saying that I should have this
done. All of this info goes to a caseworker at Healthcare International,
which serves as sort of a clearing house for WLS approval. If they put
their stamp of approval on it, I should be good to go. (But you never
know, KP could deny it for a miriad of reasons.) So there's your long
answer to a simple question. The short answer is to check under insurance
carriers in your area and see how KP has worked for people there. I am
praying that I get approved, but as you can see, I'm a bit nervous. Good
luck to you!
— rebeccamayhew
March 3, 2002
Hi, I notice from your profile that you live in Stockton, CA. Please click
on my name at the end of my post and check out my profile (it's 2 pages, so
be sure to link to the 2nd page). It will tell you about my journey with
Kaiser Northern CA.
— [Deactivated Member]
March 3, 2002
Not only has Kaiser approved me for WLS- I am a 20 year employee in San
Diego- Kaiser does have stricter BMI requirements than other insurances-
and you have to have had Kaiser insurance for at least one year. I know for
sure that the requirements for No Ca are much stricter than in San Diego- I
did not have to see a nutritionist, or weight loss counselor- just have a
primary MD that SUPPORTS WLS (I saw him 12/28/01 and received my approval
letter within 2 weeks, that was after my previous MD told me I didn't
qualify!)- for this region that is the biggest hurdle-
Once I had the referral to Pacifice Bariatric- they scheduled an
internist, psych and surgeon evals- and I am waiting for my surg date-
so Kaiser can be difficult, but not anymore than other insurances- the
secret is knowing how to play the games...I have noticied that quite a few
LA and NO CA people have surgery in SD...Also of note, here in SD rumor has
it that Kaiser will begin to do their own surguries in the upcoming
year--the means that the wait list could GROW- due to the reduced
resources....anyway best of Luck to those beginning their journey this
week-- may you find the road an easy trek.....and all those waiting---our
time will come!!
— ~~Stacie~~
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