Borderline Bmi 41.3 and Kaiser

[Dannipo 86]

Yes they weigh you at the first class and give you your weight that's why I don't really remember that was almost 10 months ago for me!!

[RebecaSparkles 247]

Yea. My primary care doctor is not happy about my decision to do this at all. She is the least supportive person on my healthcare team. My GYN is behind me full force. My Nut is cold & I don't really like her as shes 95# sopping wet & is very condescending with me. I switched Nut to a different one that I have the class on with tomorrow.

Anyways, thank you so much and I reeally rwally appreciate it as kaiser info on the web is mostly just about kaiser california. There's so little info about Kaiser va/md/dc that I thought they waited out all the people who wanted wls. I half suspect the class that I'm going to will be only 1/4 full.

Ugh. So frusterating and if it weren't a sin to pay out of pocket when I have coverage I'd just find a way to do it.

I guess I'm more worried of complications & the insurance not paying for them if you go out of pocket.

[jenakaela 24]

When do they weigh you at the first class or the nut? I'm stuck between losing or staying the same right now. I'm having a hard time not losing. Which is actually a problem bc I don't want to not qualify.

I'm horrified of paying premiums about 350 a month and almost never using the damn insurance & then going through all these hoops & losing the 10% & then to have them deny me.

If I have that happen I will feel very cheated.I know that if lost 10% which for me is 22# that I will be at a bmi too low for wls (37.5)

I pay out of pocket for my ins & I think I could cancel at any time. But I was much skinnier when I got kaiser & not on meds for Bp or diagnosed with Pcos. I doubt I'll have an easy time finding a reasonable plan (1000deductable, 30% co-insurance,3-400 a month) with a different carrier such as aetna or united.

Anyone out there had any luck with other insurances in virginia?

Thanks!

Hi Rebeca...if you're worried about your bmi going under 40 after losing the required 10%, no worries. Kaiser will except your highest wt with bmi of 40+ no comorbidities or 35 with comorbidities within 12mos of weigh in. I'll use myself as an example, I have no comorbidities, my wt on record was 316 bmi 46-47 12/19/12, highest wt not on record 322 1/3/13, currently I weigh 287 bmi 42, if I weigh 260 bmi 38 at preop appt or day of surgery, I'll still have surgery because Kaiser accepts your highest wt that qualified you to begin with. I think the qualification process is the same for all Kaiser members across the board, whether you're an out of pocket member or through employment.

I also read that your pcp is not supportive of your decision...that's not kool. You should consider looking into getting another pcp. I found that for me personally, the more supporters you have the better off you are. I didn't tell very many people about my surgery, but for sure when I'm post-op, if I'm asked I have no problems with sharing my journey. I hope the above information is helpful and if you have any questions feel free to ask me.

Lota

[RebecaSparkles 247]

Yeah, I'm looking into switching but I had. A " touch " of pnemonia at the beginning of march & wanted to get my health back before switching. I honestly still feel like crap after taking 2 weeks off and having Fluid in my lungs. I kept coughing til I vomited to the point that I lost 8# in one week & was put on anti nausea meds that made me high as a kite!

Had to stop taking them bc I couldn't function but then I'd vomit. Thankfully my cough died down & my lungs are mostly dry though I still feel a bit of fluid/ mucus.

Glad to hear my weight tomorrow will be the weight on record. I can stop trying not to lose and just be. I suspect the first 10 will come off fairly easily. The second not so much. If diet & exercise worked for me I wouldn't be here.

I am worried that I'll resort to a crash diet to get approved & then get approved. But have issues bc i'll have gained it back in the 3-6 months I'll wait for surgery.

Anyways. That's a problem for future Rebeca to deal with , i'm going to make puppy snuggles in bed!

[twins1978 0]

Hello

You look great

[RebecaSparkles 247]

Hi Twins! Thanks! I'm 5"2 227 very apple shapped. Thinner arms & legs, no varicose veins ( knock on wood) i've got that going for me. All my friends have the veins in their legs since sophmore year of college.

I used to be a championship figure skater until I broke my coccyx in 9th grade & lost the nerve to jump anymore. Then the weight really came back , I was heavy from 1 st grade thru 6th lost it by getting into skating & karate. I've been the fattest or nearly the fattest of all my friends ever since.

So ready to be rid of this extra weight. I was going through the process last year but I was accepted into a hoity toity university far away & got married so I felt it was too much on my plate at the time.

I don't regret getting married at my before weight though, I know that deep down my hubby loves me at my thickest, I made sure he knew I was an as is purchase and made no promises about losing or gaining after marriage. So, if I do lose the weight then its pure win for him because he gets an upgrade.

[RebecaSparkles 247]

Are they going to weigh us privately or in a group setting? Will we have to wear a gown?

Little nervous, is it like WEight Watchers? Semi-private?

[RebecaSparkles 247]

So, I went to the Kaiser Weight Loss Surgery Class 1.

Here's a run down of what happened:

We signed in showed our member cards and our drivers licenses.

The NUT began going over the paperwork that was in folders they gave us. Pretty much a snooze fest here.

Asked us to start recording our food and beverage intake and to fill out the homework forms for our next visit one on one.

Pretty much a brief overview of serving sizes of fruits and vegetables, showed us the plastic food, etc... Nothing exciting.

There were hand outs on exercising and dieting and healthy changes to make.

Then the big guns: we had to lose 3% of our current body weights by the end of the 6th months or else our paperwork would be on hold until then. (as mentioned by another poster)

She laid out the kaiser visits, they must be no less than 1 month apart (one a month was how she said it):

Visit 1- was the class we were at

Visit 2- Nut appointment just for you

Visit 3- Nut appointment just for you

Visit 4- Weight loss surgery class 2

Visit 5- Nut appointment just for you

Visit 6- Nut appointment just for you

Somewhere in there you must call and do a phone screening for the psych eval. If they aren't satisfied they'll have you come in or they'll clear you over the phone

Also, you must have taken the Weight control class at some point during the 6 visits, or in the past year- which is a one time class about general weight loss for everybody. I'd already taken it but it was over a year ago so I get to go again! yay

She went around the table and asked everyone what they were leaning towards.

Then took us over to OB/GYN and weighed us one by one and took our height measurements.

The NUT then calculated a "goal range"/ expected weight loss amount and final weight. She put me at 170-180 ( loss of 55-65 #) That seems like not enough loss. I think they're overly conservative with their numbers because I see people on here and in real life who get down to much more loss of excess weight. Never even asked us where we'd like to be.

Anyways, They did say as another poster commented that if your bmi dips below the kaiser cut off (bmi of 40) during the loss of the 3% it won't disqualify you. However, my bmi was 39.1 a few years ago and she said that she wasn't sure if I'd be approved due to that and she'd submit me to the obesity work group for a pre-approval or denial based on that pre-requisite.Then later that night, she eneded up emailing me back and saying that she checked my file and saw that I did have my pcos & high bp documented and that I was all good.

She said for Virginia they use the Virginia Hospital Center in Arlington, They have an exclusive floor just for kaiser patients. Not sure if that's good or bad. The local hospital Inova FairOaks is an Center of Excellence in Bariatric surgery, and it irks me that they're going to make us go to a less awesome hospital. Nothing I can do about that though, so I guess I'll stop whinging about it.

Anybody have Dr. Salameh or Dr. Mayes ?

[ISleevedIt 379]

Hi, I'm in VA and was sleeved by Dr. Mayes. 2 days shy of a month. My BMI was 40 point something. Once I was weighed in, the nut told me she wasn't sure if I would be approved or not. it went thru a pre-approval process where they told me within a few days that I was approved for the program. As long as you do everything they tell you, then you will be approved. The appointments need to be a month apart or they will have it typed up in the instructions. Noticed that in my signature, I did not have an appt in Dec because I was a little too early and the NUT had me skip Dec and come in Jan.

Virginia Hospital Center is great. I loved the fact that they are private rooms. I was given excellent care there and have no complaints.

You will need to take the free seminar with Surgical Associates of Virginia, the doctors' office. Do it during your 5th month or so because then you won't have to wait to take their seminar after you get the final approval and referral to the surgeon. Kaiser decides which doctor you get. Virginia Hospital Center is a teaching hospital. The day of my surgery there were no interns to assist so Dr. Parker (another doctor with their practice) was the second doctor in the OR.

Oh, Surgical Associates has you sign a form that you will go to 3 of there WLS support groups. My first one is this Thursday. The doctors' office is right in the building with the hospital.

Hey Kaiser requires you attend their WLS support group during the 6 month period. I started going in Oct and have kept going. Nice to get people's perspective that had already had the surgery through the same doctors and insurance. Maybe I'll see you there. The next one is March 26 at 7pm at Kaiser Fair Oaks Medical Center.

[RebecaSparkles 247]

Do you have to go to the surgical associates or kaisers support groups? Both?

Three before surgery or three after?

I will be there at the fairoaks meeting. Do they weigh us in or anything?

What's it like?

[RebecaSparkles 247]

Oh, and what was your out of pocket?

I have a 30% co-insurance... Trying to estimate to save up!

I forgot to say I'll be wearing a bright green dress at the meeting so you won't miss me!

[ISleevedIt 379]

Hi Rebeca,

Both, Kaiser support group is prior to surgery. Surgical Associates are the surgeons Kaiser uses. They require you attend 3 of their WLS support groups after surgery. I willhave gone to my first one before the Fair Oaks meeting.

There is no weighing in. We get cards to put our names on it and they are color coded. Green was prior to surgery, pink the bypass, and blue the sleeve. Oh, by the way my name is 'Helen'. I'm Asian so you'll be able to tell who I am...lol

Kaiser varies based on your company. Mine has great benefits. I just have $5 copay. So I pay $5 for each of the WLS classes/NUT visits. And I got a bill from Dr. Mayes for a whopping $5.

Looking forward to meeting you.

[maharet111 544]

I have Kaiser Ohio and I didn't qualify at all. BMI was too low as they set theirs at a minimum of 43. I would have had to gain another 60 pounds just to qualify.

So I self paid.

[RebecaSparkles 247]

Yeah, the difference between a bmi of 40 & 43 for me is 13#! So then the question is , exactly how much are those 13# worth? Answer about 12k.

Luckily, I qualified but if I hadn't you bet I would gain that weight pretty quick.

I self pay for my insurance so I could choose to swap if I had to. I figure as a back up I'd self pay but I'm worried I'd get complications and have huge medical bills so better to get insurance to cover & they'll take care of complications after co-pay / out of pocket max.

[RebecaSparkles 247]

So, Today Was Visit 2 which was a 1 on 1 with the LD NUT. I actually liked her, I very rarely like NUT's, but she's leggo McPreggo and about to leave for maternity. I was kinda upset about that so she agreed to go into the computer and make my next 2 visit appointments for me yay!

We discussed my Fluid and food records. (thank god for My Fitness Pal) She gave me a goal of eating less lean cuisines and more veggies. I hate veggies. I loathe veggies. I agreed to eat more salads but we'll see how that goes. As long as I don't gain and meet my goal of losing the required 3% I don't see why it much matters what I eat pre-op 6 months out. If I were 2-3 months yea, I get it, make changes make them stick so it's not a shock.

Anyways, I'm down a total of 7.6# so I made my 3% in one month!!!! I got the stomach flu going around my office and have been pukey lukey all weekend, not really eating too much. Wasn't easy, really sucked actually. But, I'm a maintainer. I can keep it within 2-3 pounds from now to August. I figure I'll do a unofficial pre-op liquid diet to shave off any remaining pounds when I get closer to the finish line.