I just found out I was turned down by Kaiser. They said I do not qualify.

My BMI is 37.5 and I have HP which I have been on 2 meds aday for years. I also have high cholesterol and triglycerides, I guess my numbers are just not high enough. I am really disapointed.Has anyone fought Kasier on this and won?

Edited August 2, 201016 yr by humpty dumpty

See my new post!

Edited August 12, 201015 yr by humpty dumpty

What a bummer! Do you have to have one or two co-morbidities if your BMI is 35-39? I don't remember. I thought that hypertension counted, but I haven't seen anything about high cholesterol. I could see that one as being iffy since obesity doesn't always mean high cholesterol and vice versa. Have you ever been tested for sleep apnea? I know that seems to be another of the big co-morbidities for consideration. You might not think you have some sleep/breathing issues, but you just don't know. If you had asked me a few weeks ago if I did, I would have said no way!! But, my husband has told me that I snore a lot. He never told me that before! It was usually if I was really tired or sick. Snoring doesn't mean you have sleep apnea, but it also doesn't mean you don't. If I wasn't considering this surgery, I would go ahead and have myself tested just to be sure. However, my BMI is over 40, so I qualify already, and I don't really have any comorbidities. Good BP, decent cholesterol, no major weight-related health conditions - a fairly healthy morbidly obese person.

While I don't know how to go about appealing, I do think you might want to talk with your PCP about being tested for sleep apnea. Are there any other weight related issues that you have? Do you see a specialist for any other conditions that weight loss would help improve?

Don't give up hope![/QUOte

hello well i just went to my 1on1 on monday i was told that kaiser "so cal" has changed there bmi to 35 with no comorbidities i ask because my bmi is 39 so i was worried that i would be denied as well i start my 12wk classes on 8/20/10 an i finish on 11/5/10 and she said that i should have my surgery in dec 2010 if i do everything like im suppose to the surgery will be done in sandeigo ca. well i hope this helps good luck

What a bummer! Do you have to have one or two co-morbidities if your BMI is 35-39? I don't remember. I thought that hypertension counted, but I haven't seen anything about high cholesterol. I could see that one as being iffy since obesity doesn't always mean high cholesterol and vice versa. Have you ever been tested for sleep apnea? I know that seems to be another of the big co-morbidities for consideration. You might not think you have some sleep/breathing issues, but you just don't know. If you had asked me a few weeks ago if I did, I would have said no way!! But, my husband has told me that I snore a lot. He never told me that before! It was usually if I was really tired or sick. Snoring doesn't mean you have sleep apnea, but it also doesn't mean you don't. If I wasn't considering this surgery, I would go ahead and have myself tested just to be sure. However, my BMI is over 40, so I qualify already, and I don't really have any comorbidities. Good BP, decent cholesterol, no major weight-related health conditions - a fairly healthy morbidly obese person.

While I don't know how to go about appealing, I do think you might want to talk with your PCP about being tested for sleep apnea. Are there any other weight related issues that you have? Do you see a specialist for any other conditions that weight loss would help improve?

Don't give up hope![/QUOte

hello well i just went to my 1on1 on monday i was told that kaiser "so cal" has changed there bmi to 35 with no comorbidities i ask because my bmi is 39 so i was worried that i would be denied as well i start my 12wk classes on 8/20/10 an i finish on 11/5/10 and she said that i should have my surgery in dec 2010 if i do everything like im suppose to the surgery will be done in sandeigo ca. well i hope this helps good luck

OMG that explains it! I filed an appeal on 8/09 and on 8/10 I received the Options package, I thought ok the Dr must have been wrong. I called the Kaiser case worker on Wendesday and told her to pull back the complaint.

Thank you for letting me know.:biggrin2:

Cool! So you are good to go?

Cool! So you are good to go?

I think so, I called to set up the options seminar but the nurse is out until Monday.