PEBB Employee Kaiser Oregon

I am new to the forum and looking into getting the sleeve. Currently, i have Providence but I don't qualify for the surgery because I don't have sleep apnea or diabetes. I will have Kaiser at the beginning of the year 2014. I wanted to know if they required co-morbidity as well as BMI of 40. I am overwhelmed and confused about hot to start this process. I called Kaiser and they didn't give me a clear answer just transferred me to a voicemail and I supposed I should hope I get a call back.

HELP

OVERWHELMED

If you have not done so please post this on the Insurance, Cash Pay and Financing  Keep us posted on how you are doing!

Regards,

Member Services

I don't want to add to your confusion, but . . . you should know, because I didn't -- if you have weight loss surgery as a state employee under PEBB, if you retire early, before being eligible for medicare, and need to buy the state employee's retiree insurance, you will not be covered for any complication arising from your weight loss surgery.  I've just had to repay a bunch of claims because they found out I had weight loss surgery and think anything related to abdominal pain is related to bariatric surgery, which they don't cover.  They don't tell you this stuff when you retire.

I am actually going through the process with Kaiser right now, although I'm down in Southern California.  The basic rules is you either have to have a BMI of at least 40 with/without comorbidities or you have a BMI of 35-39.9 with co-morbidities.  They define those as diabetes, sleep apnea or other medical conditions directly related to obesity.  I'm not very far in the process (I'm moving on to doing the lab work and EKG toorrow), but I do have all of the paperwork from the orientation so please feel free to ask if you have any more questions.

Of course we can exchange e-mails!  I'll send you a message through your profile page.  I'm definitely ready, too.  At first I was scared at the thought of having a surgery for weight loss, but now I can't wait to get started.  There's always a little fear when surgery is in the discussion, but I know without a doubt that it's the right thing for me.

Hi!  I am going through the process with Kaiser in Portland right now.  I don't know what Pebb is.  I know OEBB which is the Oregon Employee Benefits. I think if you are over 40 you do not need some of the comobidities.  You will need to show that with a BMI of 40 that you cannot lose it on your own.  I have OEBB and I had to do a sleep study and show I had sleep apnea, prove I had been on a weight loss program for a min. of 6 months, show a weight loss trend through office visits.  I also had to show I had GERD.  No comorbidities doesn't only mean diabeties or high blood  pressure.  You PCP will have a list of qualifiers.  You will be given a referral and then they will review to see if you meet the program standards.  After this, the program will send you a questionaire.  After you complete this, you will have to take a class that is Managing Weight Management which is between $85-$150.  Then you will be invited to go to a seminar.  I have mine on March 7.  After that, you will have to take another two hour class.  Then you have to show several months of weight loss.  Be careful, if you are sitting at 40 and you go under with the expected weight loss you may not qualify.  Let me know where you are in your journey.  I would love to have someone to go through this with.  I should also tell you, Kaiser in Oregon will only do the RNY.