Revision to DS covered under Kaiser CalPERS

Nov 21, 2016

I JUST called up Kaiser Member Services and said I was looking for more information on their Bariatric Coverage. My Evidence of Coverage Booklet merely says:

"Bariatric Surgery We cover hospital inpatient care related to bariatric surgical procedures (including room and board, imaging, laboratory, special procedures, and Plan Physician Services) when performed to treat obesity by modification of the gastrointestinal tract to reduce nutrient intake and absorption."  ... it has more verbiage on transportation reimbursement to/from facilities relating to bariatric surgery than specifics, types of surgeries covered, exceptions or whatever other details. It doesn't even specify revisions one way or another.

So I asked the representative what specifically was covered. When she asked me what I was looking for, knowing that DS might be a trigger-to-not-help-you-anymore, I evaded and said I was looking into several different kinds. She listed LSDGB, RYGB, and Sleeve with DS (!!!!!). I then asked if the coverage specified anything about revisions, and she said "repeat bariatric surgeries" was included in my coverage. Both the DS and the revision aspect are covered when deemed "medically necessary" and upon completion of the Preparatory Program. 

I did also ask if there was a Kaiser DS surgeon or if that's contracted out, and she was a little fuzzy on the answer, but said if Kaiser can't perform the surgery recommended, that they would contract it out to someone who does. I'm assuming that would be Dr. Rabkin.

The "medically necessary" part may be my river to cross, but it sounds like they're mostly on-board. I wonder if because my Kaiser Insurance is through CalPERS (I'm a County Employee) that makes a huge difference?

Crossing all my fingers for a happy appointment on December 1st!

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