How Likely Am I To Get Approved By Kaiser?

[ISleevedIt 380]

Well, I had my first WLS class with Kaiser. When the nutritionist weighed me and computed my bmi it was 40.3. Since my blood pressure is under control and I'm not on any medication for high cholesterol (even though my LDL is well above normal), she wasn't sure if I would qualify or not and have to put my case before the OWC committee for approval or denial. What are my chances of getting approved?

If they don't approve me, will they cover any complications if I get it done in Mexico? I am really tired of yo-yoing with my weight.

[danyelleb 386]

Oh, that's a great question. Do you have any other co-morbidities- sleep apnea, diabetes? I wouldn't stop pursuing this route if the sleeve is something you are seriously considering. I would keep working with Kaiser until they flat out tell you no. I wish you the best of luck.

[scaredoftheunknown 95]

Are you 100 lbs. overweight? If so then that alone will help you qualify.

[ISleevedIt 380]

Bummer, I am only 84 lbs overweight....I can't believe I'm upset because I'm not more overweight. The thing is I'm a yo-yo. I lose the weight then gain it back with a few pounds more and I'm tired of it. In the last 12 months, I've lost 60 lbs just to gain it a back and a few more! I want the sleeve so that I will have the physical restriction to keep me from pigging out on food. I'm not too concern with getting fat from drinking the wroing fluids since my drinks of choice are Water, diet coke unsweeten tea, and occasionally some other zero calorie drinks.< /p>

I do have high blood pressure that is under control with meds. My LDL cholesterol was high in my last checkup, but am not on any meds for it and I think I my doctor said that I had to be careful that I may be prediabetic or close to having diabetes.

As each day goes by, waiting to hear if my VSG will get approved, I feel more and more like just scheduling it with Dr. Garcia in Mexico. The only thing stopping me from scheduling it now is that KP may pay for it and I would have the follow up care.

Does anyone know if I get the VSG outside of Kaiser, that Kaiser would do follow-up care for me?

Thanks for any info!

[drewmon 7]

I didn't have KP but I'd be surprised with your high blood pressure and bmi over 40 that you would get denied.

[MeMeMEEE 206]

Are you saying high bp under control with meds? Or you don't have high bp? Because most insurances look at high bp as a co-morbidity whether it is under control or not!

[ISleevedIt 380]

Well, with my first WLS class, the nutritionist said that it would be up to the OWC to approve/disapprove me. She didn't make it sound very positive. I guess I have to try and be patient and wait until the 22nd to find out. Currently, I'm trucking on as if I will get approved and have set up a Weight Control class and an appointment with the nutritionist. I'm just hoping that everything will work out so I can get the surgery in Jan/Feb timeframe. Keep your fingers cross for me.....thanks.

[cherice95403 13]

I had surgery with kaiser. Their criteria is 40 bmi with at least one co-morbidity. If you have high blood pressure (even if it is controlled with medication) that is a co-morbidity. I would ask for a sleep apnea test now and go through that process. You might be surprised. I never thought I had it, but I did! Also, if you have pain in your hips and knees get that documented. My hips started locking up on me from the excess weight and I would fall down. Get everything documented with your GP. That goes a long way with kaiser. Good luck!

[scaredoftheunknown 95]

When I went to the program overview and they weigh me they told me I didn't qualify because I wasn't 100 lbs. overweight. I do however have a BMI of 36.5 and I have comorbitities. Then she asked why the Dr. had sent the referral. When I told her my comorbitities she said that anyone with the comorbitites qualifies. I was still unsure and I called the membership department to ask if I would qualify and they said yes. Good luck