Anyone know if Kaiser in Northern California approve the revisions??

Sheri Y.
on 7/11/12 3:26 am - Napa, CA
Just wondering if anyone knows if kaiser covers weight loss revision surgery?? I had RNYdone in 2002 and never lost all my weight. I had lost almost 200 pounds, but still was at an healthy weight of 275 and have now gained 100 pounds :(I have been reading about the fix's. But not sure how well they work.
Hislady
on 7/11/12 9:11 am - Vancouver, WA
sfnativewm
on 7/11/12 11:28 pm

I belong to kaiser ssf.  They have done revisions when they feel they deem it necessary.    I am not sure which kaiser near your area does wls.  Perhaps kaiser richmond, and they are loved!!!!

I would basically write down a journal and document all your concerns and failures.  Contact bariatrics and get an appointment and see what happens.

Sorry I wish I could be more help!
~ann

~Ann~
Band removed and feeling alive with energy!

aquesta
on 5/15/18 3:55 pm

Hi, looking for help and suggestions. I had a vsg in 2013 didnt lose the amount of weight I wanted, never got under 200!! I believe that i am experiencing some GERD symptoms and have had about 40lbs of regain. I am seeing my PCP next monday and plan to ask for a referral to bariatrics. Any thoughts on which site would give me the best/fastest route to revision to RNY? I was thinking Richmond because it's the closest.

Any help would be appreciated.

  • original surgery was not done at kaiser
  • do not have a formal Dx of GERD
Holdenwhat
on 7/18/12 9:59 am
 Hi- I'm a Kaiser patient looking for a revision RNY to DS.  I have been going through the SSF program as they were the ones who originally did my RNY and I'm hoping to have my revision with Dr Rabkin in San Francisco. Dr Rabkin has had Kaiser patients but I'm not sure if they were just DS or revision to DS. Anyway, his office has been walking me through the steps to try to get this covered. I had to meet with Kaiser bariatrics to ask for a referral and I was told that they have never referred someone out for a revision (and basically they were not going to make me the first one!). The dr I spoke with was anti-DS in general. I told him that I would probably appeal his decision and he informed me that he is the person at the regional level that these cases go to (and of course, when I did appeal, it was denied). I will be pursuing the next step, but that is my experience so far.

I see that Ann has responed to your message (hey, Ann- how ya doing?). She seems to have had better luck with Kaiser than I have so far, so her info may be very valuable. But if you are in the area and having trouble with Kaiser, Dr John Rabkin may be able to help you explore your options. So far it's been good for me.

Good luck.
sfnativewm
on 7/18/12 11:47 am
Hi there!  I go back on the 27th and hope to show them I need a revision!!  Fingers crossed.    I have a partner with stage 3 breast cancer and the journey goes on and on!!!    I have a bad right hip that I really need to get the weight off as I am not wanting hip surgery!!
the head of bariatrics at kaiser ssf is a female so not sure who the heck is being so ****y to you at kaiser!!!  lets keep each other posted!! 

~Ann~
Band removed and feeling alive with energy!

Sheri Y.
on 7/20/12 12:57 am - Napa, CA
Thank you both for posting! I dont even know where to start with the whole revision thing with Kaiser. When I had my RNY done just over 10 years ago, Kaiser was contracting out and my surgery was done by Pacific Bariatrics in San Diego. Kaiser paid for the whole thing! Airfare, hotel, etc. I haven't seen or talked to anyone from Pacific Bariatrics in over 8 years. I havent even been seen by anyone with follow up to my surgery since I had it. I lost over 150 pounds but never got to a healthy weight. I had gained 100 pounds back, and have taken 50 pounds off. I just dont know what to say to my doctor to get me over to SSF to the bariatric program.
Holdenwhat
on 7/21/12 11:37 am
 I'll definitely let you know how my process turns out, if it seems like it would help. Until then, I guess I would just recommend not getting discouraged. Kaiser is slow to take on new things because it seems they want a history of successes before they'll adopt a new practice or procedure. When I had my RNY, it was all they offered. Now they do the LapBand also, so they are progressing. I think eventually they will offer more options,once they see that other procedures may be even more beneficial.Until then, I guess that's why they invented someone to oversee HMO's, somewhere to appeal when you can't get reasonable help that would be in your best interest.
And don't be afraid to just ask your doctor for a referral- there's no reason you shouldn't be able to see someone in SSF. But I would recommend getting an idea of what you want before you go there. My experience was that they just wrote me off as "behavioral"- I had gone in 3 years ago to ask for help with shrinking my anastomosis because mine stretched and my stomach empties so quickly, and I had the same response- "your weight gain is behavioral". Yes, I ate the food and I certainly am not perfect but before my RNY I had already lost 100+ pounds and kept it off easily for 4 years. I am able to maintain a weight loss but not if I am physically hungry every 3 hours. Now I'm rambling.... I guess I'm trying to say, don't be surprised if you don't encounter helpful people. Maybe read these boards and see if you can figure out what is right for you. I talked with other surgeons outside of Kaiser who work with failed RNYs before I went to Kaiser to ask. All of them were willing to at least let me know what they could do to help me.

I had to go through an Upper GI and speak with a dietician before SSF would let me see a surgeon to ask for a revision. And pretty much every step pf the way I had to follow up and ask that we procede to the next step.

I'm hoping that I will get approved at the state level and be a raging success; then I will go to Kaiser and say Look! It worked! 


newgigi2006
on 12/3/14 1:38 pm - CA

Did you ever get your revision at Kaiser afterall?

 

  

Holdenwhat
on 12/4/14 2:36 pm

Hi- no, I appealed to the state level and was denied. Fortunately I was able to get the money from a relative to private pay and I had my revision with Dr Rabkin in February of last year. I am down 125 pounds so far. 

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