saoirse16

Decided against Mexico. I'm self-paying at a non-KP hospital in OR. And yeah, there are differences in the KP program by state - some states require that bariatric surgery is a covered service on all plans for that state (whether it is fully covered or partial varies by plan), some states don't have that requirement. Oregon does not require bariatric surgery to be a covered service. Sounds like CA is likely a state that does.

Hi everyone! I'm looking into having weight loss surgery and called Membership Services today to verify coverage and costs, and ask about the process before scheduling an appointment to get things started - but I was told that weight loss surgery of any kind is not covered. From what I understood in my plan details, weight loss surgery is not covered unless it's medically necessary and/or if I meet other requirements, and when I brought that up to Membership Services, they said I was not covered, period. She just kept repeating, "that procedure is not covered" as an answer to my questions. Rude. So I called OHSU to discuss their self-pay options and they were shocked that Kaiser had told me I wasn't covered. OHSU had not heard of that happening before, and highly recommended that I contact Kaiser again. Before I call Membership Services and get treated rudely again, is there some other department I should call at Kaiser instead? Is there some process or way of getting this covered by Kaiser that's not being offered to me? I've looked at the Kaiser website and it's not offering much in the way of info. I did find info that bariatric surgery is done at Kaiser, but no info on how to get to the point of actually having the surgery. Not sure where to go from here...any suggestions?

Final update: Even if classified as medically necessary, it will not be covered. Bariatric surgery must be a part of your KP plan to have bariatric surgery performed, and not all KP plans have that option.

And which program were you accepted into, fordtmacrae? Is there something other than Mastering Weight Management we're supposed to be doing?

I'm signed up for the classes & start next week. The webinar option wasn't offered to me. Kind of a bummer though to see it could be 9-12mo from now before a surgery date [emoji53]

For anyone with the same questions that I had initially, it looks like so far, everything is going to proceed. I started with an office appt to discuss my obesity & health issues with my PCP & told her I was interested in bariatric surgery. Thanks to a new development of high BP over my last 3 appts that now requires meds (boo) and a few other things, I meet most of the medical requirements (my BMI is a few points above the "medically necessary" cutoff point), so that helps my request for surgery. My PCP is on board with the idea of bariatric surgery and has referred me to weight management. I start the 12-week classes in January & have my sleep study scheduled for that month too. So we'll see what happens...

Thank you! I thought that too, especially with how our summary of coverage is worded, but Member Services was adamant that it wasn't covered, no matter what. I'll see if I can find the WL Svcs number - it's like they keep anything bariatric/weight loss-related hidden from the general public, and you need a decoder ring, a password and the super secret handshake to find it. Sent from my iPhone using the BariatricPal App

@@gaely and @@bubbles80 is bariatric surgery covered on your Kaiser plans? Or is it in the list of "not covered" and gets pushed through another way?

Thank you! I will be scheduling my PCP appointment tomorrow. It seems that's the first step I should've taken to begin with. Whether I go through Kaiser or not, I'll need my doc to be on the same page and at least know what's going on with me. Sent from my iPhone using the BariatricPal App

Can I ask who your surgeon was in Mexico? I am researching now for surgery. Sent from my XT1055 using the BariatricPal App I'm interested to know who the doctor is as well. Sent from my iPhone using the BariatricPal App

My hubby had his surgery in Mexico and OHSU Bariatric Center will provide him with medical care. It isn't as hard as people think to get a DR. I had my surgery in Coos Bay, and they took me on right away without a problem. That's good to know! Thank you! Sent from my iPhone using the BariatricPal App

I do understand plan vs provider. The parts where I'm stuck are (1) my plan info says something different than what Membership Services told me, (2) I thought maybe I called the wrong department to start and shouldn't have started with Mbr Svcs but possibly a different department, and (3) I don't know where to start with the process, and haven't found definitive info on specifically pursuing bariatric surgery. I started with Kaiser recently, and their system in general is not what I'm used to & has been quite confusing at times. Sent from my iPhone using the BariatricPal App

@SarahWood Thank you! I'll look into that facility & surgeon as well. Sent from my iPhone using the BariatricPal App

Oh yes, I should've mentioned that I've been looking into Mexico too. But I'm concerned about post-op care/followups and getting that covered through Kaiser. Not sure how all that works? Especially if there's a serious issue some time down the road after surgery.