"Old Timer" appeal for WLS with Kaiser

I am sort of an "old timer" on the CA board as I have been reading here since 2003. Some of you may remember me.
I WON MY APPEAL FOR THE DS FROM KAISER! 
With a huge sigh of relief, I read my letter from the DMHC stating "the requested procedure is medically necessary for treatment of your medical condition. Kaiser FH Plan's denial of the requested procedure should be Overturned."
   It should never be so difficult for a patient to get the proper medical treatment. The fact that there is  this superior treatment of DS surgery as an option that is being rejected and kept  a secret by many medical groups is just wrong. I feel cheated out of years of good health because of Kaiser's ridiculous requirements  and restrictions.
It is interesting that the last part of the seven page letter I got from the DMHC touts the DS as a much superior treatment to any other bariatric procedure available, specifically citing the RNY.
     "There is a large body of scientific data that discusses the different types of surgical weight loss procedure. --The duodenal switch procedure was determined to show the most improvements among bariatric procedure alternatives (including Roux-en-Y gastric bypass, gastroplasty and gastric banding). There was significant hyperlipidemia improvement, diabetes resolution and excess weight loss reported with the duodenal switch procedure more often than with any of the other procedures surveyed. Therefore, I have determined that the requested procedure is medically necessary for treatment of the patient's medical condition. The Health Plan's denial should be overturned."
     I think that most at Kaiser know that DS is the best route, unfortunately it is the more expensive route. In all other areas, I feel that Kaiser is a very good plan for health care. No one, no matter what their insurance situation, should have to be denied the care that can save their lives. We need a choice of nationwide insurance and equal health care for all.

Gail,

Big CONGRATS to you.  I am so happy for you.  I fought for 3 years but you have me way beat.  and now the  new chapter begins.......

Sheryl

All it finally took was a little helpful guidance from Diana Cox and Larra, some letter writting, and in a few months-- I WON! 
If anyone wants some advice please send me a message, I'd like to play it forward.

you're a dragon-slayer! congratulations, and may your story inspire others to fight for their own health and freedom!

So far, Kaiser has lost every single case against them in appeals for DS WLS through the state insurance board. It turned out Kaiser is just a ***** cat!

I fought Pacificare for my RNY, and what many people do not realize is that we are very lucky to be in the state of California. The Department of Managed Health Care is truly a champion for the health of patients.

HMOs will typically stall, deny, avoid providing treatment and most of the time they get away with it because many people simply give up and walk away from a fight.

So fight on, and enjoy your new-found health!

Why did you have to fight Pacificare for RNY

Gail,
Of course I remember you....:) so glad that you are winning this case.....

Yes, the DS is suprerior to RNY for certain people...not everyone can be compliant to the post op guidelines....I know that most of the doctors here in the valley will only do Proximal RNT's because the distal takes more supplementation and they feel the patient won't follow thru. This I underestand.

There really should be more phsyc stuff on any of the surgeries......some people just haven't a clue of what they are doing....Not you..I know you do....but there is one that I know of (no names needed here) that recently had a Revision to DS and only a few weeks out asking to eat doughnuts....and they wonder why the RNY didn't work for he/she.......

Keep me posted on your journey, we must get together on my next trip up to see my daughter and grandson.....

Yippeeee For you....so happy for you.....

And yet, this might still be the best surgery choice for her if she keeps up her suppliments. Unfortunatly, she may have to suffer from the mistakes of sampling the wrong foods too soon.

Thanks for the kind words and good wishes. I would love to meet you sometime, especially after my DS so we can compare notes and ideas.

It's a date, just let me know.....