This is such a struggle--an Update
For those of you who don't know my story, I'm trying to get the DS through Kaiser of So Cal. Thus far I've been referred to the Options Program (Kaiser's program for bariatric surgery) and approved to go through the program for any of the following surgeries: The Lap-band, the Sleeve, or the RNY. I sent a grievance through asking to wave the Options Classes (since they don't cover the DS) , to wave the 10% weight loss requirement, and to send me to an outside surgeon for the DS. My file was reviewed Friday. I found out today that all grievances were rejected. I am allowed to go see a surgeon within Kaiser--one who performs the DS but isn't a bariatric surgeon (does intestinal surgeries) but that I'm basically kicked out of the bariatrics program. They said that the surgeon would reject my request and send me back to them and that I'd then be put on a wait list for a few months before getting back into the program.
I agreed to see the surgeon--Bookfairie (Laura) is helping me with the appointment. I was upset that I am kicked out of the Options Program because if push comes to shove, I MAY have to take the classes so I'd rather just do them while I"m appealing this whole thing. I'm also upset that they're so certain that the surgeon will turn me down.
My plan now is to wait for the call to make the appointment for the surgeon, and in the mean time I'm making an appointment with Keshishian to see if he'll write a letter saying that he thinks this type of surgery is appropriate. If possible I'll appeal to the DMHC to have Kaiser pay for Keshisian to do the surgery. But at least when I walk into the Kaiser surgeon's appointment, I'll have a letter in hand that says someone else thinks it's appropriate.
BTW, I cited the DMHC website regarding the class requirement and they responded saying that was insufficient evidence. This sucks. No fun. I'm trying to keep my head up and stay strong.
Sheri
S
Did they wave your Options classes and weight loss requirement? I'll send you a PM and you can send me examples of your appeal letters. I sent a really good one and surprisingly it was not successful.
S
However, it is interesting that they KICKED YOU OUT OF THE BARIATRICS PROGRAM. That could be an interesting twist on this - retaliation for exercising your rights. Was any of that in writing? I would ask for it in writing IMMEDIATELY (before you file the grievance even, so they don't know what you are doing). I think the DMHC would be interested in this anti-patient policy.
I would argue that their statement that they were sending you to a non-bariatric surgeon (I am confused - is this Belzberg or not? and if not Belzberg, who arguably IS a DS surgeon within Kaiser, why not?) who would reject your request (are THEY dictating his response?) is a DENIAL of the DS, and go ahead and get a consult with Keshishian - that way, you can argue that you are getting a second opinion after being denied, and Kaiser has to pay for it (afterwards, when you win this whole thing - in the meantime, pay for it yourself).