Question:
What does Kaiser consider medically nescessary for WLS?

   — Stacy P. (posted on October 29, 2002)

October 30, 2002
Hi there. I found this info about Kaiser off of a friends page. Her name is Jennifer Moore. Kaiser Permanente I have found that the Kaiser Patients know more about the surgery than alot of the PCP's. I have gotten lots of information from the Kaiser Patients on this site. Kaiser will approval the surgery if it is medically necessary. There Criteria for Referral is: BMI>35 with one or more life-threatening comorbid conditions OR BMI 40-50 with at least two serious comorbid conditions OR BMI>50 with or without comorbid conditions. There Comorbid Conditions are: - Obstructive sleep apnea documented with sleep study - Degenerative joint disease with abnormal X-rays and a recommendation from an orthopedist for joint replacement - Symptomatic ventral hernia - Congestive heart failure - Diabetes mellitus - Hypertension - Hyperlipidemia - Extremity edema with ulceration - End stage renal disease with difficulty dialyzing - Amenorrhea related to obesity - Incontinence related to obesity - Low Back Pain if patient is significantly disabled, has X-ray changes in the spine and an orthopedic recommendation for weight loss and/or back surgery Additional Patient Requirements are: - Must have been under the care of a Kaiser physican for at least one year - Details of attempts at weight loss, social aspects of patient's obesity and eating patterns should be documented - Mental health consult, as determined by PMD - Nutrition consult, as determined by PMD You must also complete the required lab work and have an EKG. My doctor was sure that I need to be on a medically supervised weight loss for 1-2 years, but that is not so! I asked my doctor to refer me for surgery a number of times. Finally I wrote up a letter stating my medical history, family history, weight history, and my knowledge of WLS, he agreed to refer me immediately.
   — [Deactivated Member]