Need advice on bypassing Kaiser options program

Hi all,  I am fairly new to the boards however, I was hoping I could get some advice from anyone who has any knowledge on the subject.

Anyways,  I have Kaiser through my husband's employer.  We are going through a divorce which should be final in the next 2 months of so.  Once the divorce is final, I lose my medical insurance.  So I am considering possibly filing a grievance with the DHMC so I could bypass the Options requirment and just go straight to surgery.   My start date for Optoins is March 22nd.  From what I was told by the case nurse, I would finish the classes June 15th, so I would likely have surgery between July and August 2010.    I would really like to take the classes, however if I do, I likely won't be able to complete them since I won't have Kaiser anymore.  So as stated previously, I am considering filing a grievance to bypass the classes.  Does anyone know how long the whole process takes from the point that I file, and the response from  the DHMC? I've read someone say a month and someone else said 3 months.  Any input you have would be greatly appreciated.

Thanks. :)

My opinion and this is mine alone. You really need those classes. Life after WLS is not a piece of cake and anytime you can get classes on how to live after would be a great benefit to you. Surgery is not all that easy. You need to learn how to live a whole new lifestyle and it isn't easy. 

Just my opinion.

Hello,

I'm so sorry this is happening to you.  Being in California, you should be able to get COBRA coverage if your husband works for a large company.  That way you can pay for your Kaiser coverage.  It would be a good idea to have continued coverage after your surgery as well so that you can get the follow-up care.

I'm part of the Northern California Kaiser group.  They have a great program.

They wont just let you bypass, you learn so much information that you really need. If you dont take them Kaiser wont do the surgery.

It's true that Kaiser won't "let" you skip the Options classes, but you can file a grievance to get out of them. Kaiser will deny your grievance, but the DMHC will back you up.

     Try contacting Danas - she posts mainly on the DS forum here on OH. She successfully appealed her way out of the Options classes, AND also successfully appealed to the DMHC to get the DS, which Kaiser doesn't offer. So she knows the whole process.

Larra

It may take awhile but you can do it and I'm not sure how your relationship is with your soon to be ex-husband but I know for my employers if my status changes DURING the year UNLESS I put in the paperwork to take my spouse off it doesn't happen automatically and it still won't happen unless he changes it during the open enrollment. 

If you guys are on decent terms maybe he can just NOT file the paperwork and change the status.  You are also going to need some medical followup after sugery your labs for the first 3, 6, 1 year and then annually after that so make sure you have an idea of how you'll get those done if you dont' have insurance.

Ms Shell

The appeals will take a while, time she is saying she does not have. And it depends on her soon to be ex's employer, my employer does our medical off of our filed dependents for our taxes so we can just have anyone on there.

But thats MY employer.

 

 

Best of luck to you dear.

The classes are valuable, however with doing your own reading and research you can prepare for surgery in much less time. (Please make sure you do this, it will be a key to your success)

Your cir****tances are kind of different, I'd put a rush on things too if I were you.

You can bypass the classes by filing a grievance. You can do it somewhat faster by hiring someone to help you. My attorney who helped me get approved has also helped Kaiser patients bypass the Options classes. They are lengthy, and drawn out and are set up in such a way that if you miss a class the process becomes really long.

Contact him right away and see if two months is enough time to file an appeal

Walter Lindstrom: www.obesitylaw.com

He's a fabulous attorney who specializes in helping patients get approved for surgery and he has a lot of inside knowledge of the industry...not to mention he one aggressive guy! Definitaly someone you'd want on your side.  His staff will consult with you for free and will be very honest about your case and what is possible.

Good Luck!

 

It can be done in about 2 months if everything goes perfectly. You need someone at Kaiser to tell you the classes are a requirement. Once they do, go online (kp.org) & file a grievance against the classes. It's under "Locate our services" & then "Contact Member Services" & finally, click on "General Concerns? Use our grievance form". Scroll all the way down & fill it out & then submit it. Don't bother printing & mailing it in, they'll say they never received it. Kaiser will deny your grievance & then you can submit an appeal. They'll deny that & then you can file a grievance with the DMHC & they should rule in your favor (if you have a good appeal letter).  That's basically how my process went.

There's a little more to it, so PM me if you'd like more info, or you can check out what I have on the blog part. It's pretty detailed.

HTH

I appreciate all your input and I have a great deal to think about.  I am on good terms with my soon to be ex husband, so I am trying to come to some agreement with him in regards to Kaiser.  In the meantime, I would like to know what my options are, and what my possible backup plan should be in case he says no.  He stated he would give me a definite answer on Monday.  So I am crossing my fingers.   In the meantime, I will PM you Danas, for more info.  :) Thanks again you all for reponding. :)