Sorry for the length!
Hello everyone. I'm a newbie, this being my first post, but have been lurking here for a few months. I truly appreciate all the invaluable information you have provided to people like me who are just now entering into the whole process. I thought I'd share with you what I learned yesterday when I went to my first Kaiser Permanente Options Program orientation, as far as the hoops you can expect to jump through towards obtaining insurance approval in my area of the world.
I am in the North County area of Southern CA, about an hour from San Diego. My first step after confirming that my KP insurance plan covered bariatric surgery was making an appt. for a referral with my PCP. Luckily my doctor is a wonderful guy and he whole-heartedly supported my request. From the experiences I've read here from others, I thought he had to draft up some kind of formal letter, but nope. He just gave me the phone number for the Positive Choices Wellness Center in San Diego. I called them that day and was told that they would be sending me a packet and once I read it and still wanted to proceed to call back to be scheduled for the Intro to Weight Management class and also a Bariatric Orientation. Both of which are requirements. The classes are only given every other Thursday.
So I attended both of these. The weight mgmt. class only discussed non-surgery programs that KP offers, like Opti-Fast. and lasted for a couple of hours (some people there were not interested in surgery). After that was over then they had the Bariatric orientation, which lasted about an hour. The first thing we were told is that the entire process (pre-surgery requirements) will last on average about nine months and there will be a lot of waiting involved in between steps because of a backlog of applicants. Then we watched a short video showing some people in the options classroom as well as past patient testimony. We were given a 9 page pre-program questionnaire to fill out at the end of class, which covered things like body image, support systems you have in place, weight loss goals, diet history, weight history, health and emotional history, and an area to write a few paragraphs about anything else you might want to share with the "options team".
Good news: They have done away with the requirement that you have to provide them proof of past diet history, like weight logs from Weight Watchers, or receipts from Jenny Craig, etc. You still need to write that info in on the questionnaire, but you don't have to provide any written proof. The BMI requirements are pretty standard. 40 and up, or lower BMI's with accompanying issues.
Bad news: They said it will take anywhere from 6 to 8 weeks for them just to review and process our pre-questionnaires which determines whether or not you will be accepted into the Options Program. And she made it pretty clear that it falls under the "don't call us we'll call you" banner. So right out of the gate you're back to waiting for a good while.
She then went on very briefly to discuss what happens after you finally get the call that you'll been invited into the inner circle. You'll next be required to undergo a battery of labs and tests. You'll have to come back to Positive Choices to meet with a Dr. Ray (he is some head honcho in the program) for a one on one consultation. It's at this appt. that your official weight will be recorded. They said they expect us to lose10 per cent of our excess weight before surgery, so you have a pretty long time to do it. We will at some point be enrolled in their 24 week Options Classes. One class per week (you aren't allowed to double up). If you miss a class you have to make it up.
She said their surgery is contracted out to Pacific Bariatric and the surgery would be done at Scripps Mercy. PB surgeons make the final determination on whether you are operated on or not. At some point you will be required to attend their (Pacific Bariatric) internal orientation class, surgical consult, your psych eval too, and I think some more labs, but she said these should all be scheduled for the same day.
They only offer three types of surgery: gastric bypass, vertical sleeve, and lap band. But, she stressed that in the past year they've removed about 40 lap bands and have only inserted one. So they are definitely not on the lap band train. She wouldn't go so far as to say that you can't get a lap band, but it's unlikely.
Anyway, sorry for the length, but I hope this is helpful info. I've only gotten my pinkie toe in the Water so far and a very long road ahead, but I'm psyched for the journey! Thank you all for allowing me to soak up your stories as well. I really felt like I went into this with my eyes wide open because of you.
