OMG, I hate Kaiser

My old PCP has changed his mind and decided that nope, he no longer wants to do the referral for me. Apparently, I have not established a relationship with him. Mind you I have been bounced around from PCP to PCP since my old PCP, whom I had since 2002 up and retired leaving my referral pending a sleep apnea test that I couldn't do because I was recovering from a breast reduction. Yep, right in the middle of my surgery, she up and retired and left me out to dry with one PCP who told me all my problems were caused by not drinking enough water and exercise. I won't even go into why thats not possible without a laundry list of drugs to even walk a 1/4 mile. So this pCP was all good until the baratric program people started asking him all these questions and sending him paperwork, so he decided that it was best to "establish" a relatiohsip with a new PCP. I moved to a freakin new county. I don't even know how to get to places without map quest, how am I supposed to do all this. And to make matters worse, the icing on the cake was that while all my medical conditions, albeit, not life threatening but sucks non the less can help me qualify, I have not established a relationship with a PCP. Try Optifast. As a single mother, I can't afford to pay for the surgery on my own. Any suggestions on what to do. Apparently here in Orange County, you don't need a referral for Options Orientation. But some OC doctor( not the PCP) evaluates you to see if you qualify for the Options classes and the surgery. the PCP refers you the the surgeon or some crap. So now I am all confused, frustrated and thoroughly disgusted. Why can't Kaiser be uniformed in their processes. Does anyone have knowledge of the Orange County Kaiser process or knows of a good supportive PCP. I have no luck with these people. And I am ready to call it quits and change my insurance to someone else come Jan 1. Nikki

No advise here but thought you need a big hug and some love. Big hugs, Celest

Nikki, You really sound frustrated. I live n Riverside County and IM sure it works the same as Orange county.Kaiser divides themselves into Northern and Southern California. Your PCP HAS to refer you to the Options program first.After he sends in a referral then you will receive a postcard in the mail telling you to come to the orientation class.Where you figure out your BMI after being weighed in.There they ask you to fill in times and days that you would be available for the classes.Then in a couple of months you will get a call or a postcard telling you when you start the Options program.It is an hour and a half once a week for 24 weeks. You can only miss three classes but have to reschedule them and if you miss more than 3 they make you start all over again.After the 24 weeks then they get you started with the surgeon,and all your preop tests-then you might have surgery in a couple of months. Good luck Gaylene

Thanks Gaylene. I spoke with the Options manager Janet and I can take the orientation class without being referred. I thought the same thing becuase in LA, you have to start with a referral. In Orange, you won't get to see the surgeon without a referral for the program but you can go to all the orientations you want to. If the Euclid Dr doesn't think you qualify for the program then its a no go for the classes regardless of what your PCP thinks. Which is why I am so confused. Who grants the magical wish of surgery and what are they looking for so I can start with the class. By the NIH of meet all qualifications, especially since my BMI is closer to 50 than it will be to 40 even with a 10% required loss. I would just like a basic sheet telling me to qualify you must meet this, this and this. My old PCP suggested Optifast but even on the card they gave me, they say that Optifast is for 30-100#'s and I have to loss 120 to be considered normal to borderline overweight. I guess the real problem I have is the fact that I have been going to one clinic so long that I didn't think about PCP until mines up and quit. Now its been nothing but trouble. My original PCP was not for the surgery but since I was so adamit and so determined she was willing to go to bat for me. Now she's gone and I feel a little orphaned in this. So I am not sure what to do or who to call. I am afraid that I am going to have to start all over again. The xrays, the physical therapy, pain management, etc in Orange County when it took me years to get these referrals from LA. Nikki

Wow Nikki, I hate to see that you are going through all this. As the other lady posted (at least for me) I had to see my PCP to get a referral to the Options class. I was scared to see her as I didn't think she would refer me since I hadn't seen her before this (I always saw the NP). Anyway...ok...shesh...ok I would make an appointment one last time with my PCP. Before the appointment I would write something like a letter. Listing maybe your current weight, your BMI, any co-morbilities due to weight, like sleep apnea, high blood pressure, diabetes, etc. Then I would tell me a little about the Options class. I know the website has some information. The additional information that I can tell you is that (especially if your doctor mentioned Optifast) that the class put you on an Optifast diet from weeks 6-24 and they encourage you to loose weight. Sell the point that the referral is to a 6 month program that monitors you. They also have you talk to a nutritionalist, etc. Also just arm yourself with as much information as you can about WLS, the class, and YOU. If he still doesn't want to refer you, then appeal it or change doctors and when you do contact the doctor before hand and find out their feelings about WLS and whether they'll refer you to Options. Unfortunately besides Kaiser being a thorn in many of our sides, no matter what the insurance you run the risk of getting a doctor who doesn't refer for WLS. As for me I will be changing to BlueCross California Care HMO effective January because I want the LapBand and lord only knows when Kaiser will get on board with that one. I also see that Kaiser is just behind the times. Girl whatever you do keep fighting and don't let the frustration lead you down the wrong path. If this is what you want, then do whatever you can to do it! Don't let 1 doctor deter you because for every 1 doctor against WLS I'm sure you can find 5 who are for it, you just have to have the determination! Good luck! Ms Shell xoxoxoxo

Nikki, Let's start from square one... 1) Search for someone on this board who is in or around your city and find out who their PCP is. 2) Call Kaiser and make sure that PCP still exists. If he/she does, switch to that Doctor. 3) Make an appointment for a Gastric Bypass Referel. Make the appointment for the morning and fast (for at least 12 hours) from midnight the night before until after the appointment the next day so you can get your blood work taken care of on the same day as your PCP appointment. 4) Inform the PCP that you're fasting so he/she can refer you to the lab THAT DAY. 5) Take the time out to explain "your sad story" and make sure the PCP prepares the referal for you to fax over to Weight Management right then and there! 6) Find out the phone # of the Weight Management Department at the Kaiser they'll be sending you to and begin a relationship with any person, with ANY authority that will listen to you. 7) Stay on top of them and call and bug them if they are supposed to call you at a specific time and don't. BE NICE...Be really, really NICE- especially to the underlings...you will TRULY be remembered and given priority if you're super cool and super sweet! This is my experience SO FAR...I hope it helps!

I love this board, you guys are awesome. I have been speaking regularly to Janet who is the director for the Options Program here in Orange Co. I am going to call her after lunch. My ob order complete labs and did a physical so I have my labs in Orange Co already, unless there are more. I did the fasting blood sugar, cholestrol, CBC( which I am afraid I'll be rejected from the RNY because of servere anemia). If there are more please letme know because I will request them today with the new PCP. I am making an appointment to see him next friday. I was also told to call member services and file a compliant because i have done everything my old PCP requested including the South Beach diet, the referral was sent to the Baratric dept last year but was kicked out because it was incomplete. So that should prove that I have been trying over a year for this. And I am asking anyone and everyone I know with Kaiser who there PCP is and if they are for WLS and under what conditions. Gee****s amazing how many people are skeptical about this as a real option to fight obesity. So many are uninformed. Also I have checked out that optifast that they are peddling and think it would be an excellent resource to aid in losing the 10% but results show that an average loss of 52# in the six months of the program. That would get me to a BMI of 40, which would still qualify me for WLS. So to me, thats a no go. I guess its time to get my fingers ready to call and write to anyone who will listen becuase there is no way that they are going to get me to change my mind about this surgery. Nicole

If you have the option of NOT doing THEIR Opti-fast, I would recommend Medifast online. They have bars, oatmeal, soups, drinks and shakes- which don't taste too bad! You may want to do THEIR Optifast so they have a record of it...but make sure they actually DO have a record of it (keep your receipts). Memeber Services is a GREAT idea...Complain! Try to sound SAD- they like that! LOL!

Hi Nikki, I feel so sorry for you. I can only imagine how frustrasted you are. Keep fighting for you and your health. You deserve to be the best you that you can be. Things will eventually work out, it might just take a little more time. For a little luck...... Kelly

OHHH Girl! Just giving you a Big-O Hug!!! Sorry you are going thru this DRAMA!