Seriously Kaiser!?!

[lunarose 97]

Hi All, I have Kaiser was denied because my BMI was 36 and they do not consider hypertension and high cholesterol as qualifying comorbidity so I went the self pay route and am very happy with my sleeve 5 weeks out. I called Kaiser to get a consult with their barriatric doctor so he can coordinate my care with my PCP. So the nurse calls me back to schedule the appt and get some info. When I told her I had been denied and went the self pay route she got a little uppity and implied that the 40BMI or greater or 35 or greater with either type 2 diabetes or sleep apnea is some kind of medical/government standard and that my surgeon did something wrong by doing the surgery! Anyone hear of this? I was so happy yesterday when I saw my PCP and my b/p which wasn't being well controlled before surgery was 93/57 and am officially off both blood pressure and cholesterol drugs. Now I am worried I'll get some lecture when I go in.

Nancy

[DougNichols 124]

Now I am worried I'll get some lecture when I go in.

Remind them that you're the paying customer, and to save the lecture for somebody else.

[lisabug 10]

That is ludicrous. The NIH lists high BP and high cholesterol as comorbidities for WLS. I would find a new dr if possible.

[Lisalu 89]

I'm evil. I'd send the nurse the NIH guidelines in an outrageously nice and edifying letter. Passive-aggressive? Yes, but deeply satisfying.

[Was a humpty dumpty 35]

This what I found.. I just don`t get Kaiser.

NIH Requirements for Weight Loss Surgery

The National Institutes of Health (NIH), a division of the US Department of Health and Human Services, is considered one of the world's foremost medical research centers. The NIH has set patient criteria for weight loss surgery which states that eligible patients should have a BMI of 40 or higher (morbidly obese) or a BMI of at least 35 with co-morbidities (obesity related health conditions) such as diabetes, sleep apnea, heart disease, high cholesterol, or hypertension (high blood pressure)and non-alcoholic fatty liver disease.. Eligible patients must also have attempted and failed at previous weight loss efforts and need to pass a psychiatric evaluation to be recommended for weight loss surgery.