Kaiser Maryland?

swim13 · February 21, 2007

I currently have Kaiser insurance in Maryland. I was told that they cover the lap band on a patient by patient basis. I can not get a direct answer from anyone on how to get them to approve the surgery. I am SOOOOO frusterated!!!! Does anyone else have Kaiser? Did they cover the surgery? What steps did you take to get it covered. I have met with a dietician, psychiatrist, and now I do not know what to do from here. PLEASE HELP:(

Hunee B · February 22, 2007

Swim 13:

I too have Kaiser throug the job. I live in Maryland. I have been trying to get an answer for a couple of months and all I get is the run arounds. My doctor put in a referral for me to see the nutritionist and I ahve to complete a 6 month behavior modification program. I have been signed up to take Castric Bypass classes and though I have requested the Lapband. I'm told Kaiser does not cover the lap band but my physician saying he is doing some research and for me go to do what they require until I get an ok. It is very annoying. My physician is located at the North Capitol Medical Center.

Most people I talked to on this board who had Kaiser had to switch to another insuance in order to get approved.

swim13 · March 1, 2007

Thank you for your reply. Let me know if you find anything out. They just denied my referral and they can not tell me why. Let me know what steps they are telling you that you have to take to get it approved. This has been going on for me since the begining of January. What did they tell you? Did they tell you that they approve the procedure?

Vicki J · May 14, 2007

Hi there! I have Kaiser out here in California and they do cover the lap band. I have also heard from one person in Colorado that said they cover it there also. Kaiser in California just started covering the lap band recently from what I am told. I had to have my doctor refer me to the Bariactric Surgery Department and they have given me an appointment for an orientation to go to on June 5th. I have to have an EKG, chest x-ray and lab workup done before that date. I'm not quite sure what is done after that except that we do need to have a pysch appointment and a nutritionalist appointment. I have also heard that we have to loose 10% of our body weight before surgery. I do hope that you pursue this. I was told last year that Kaiser didn't cover it and that WLS was only offered to people MUCH larger than I am. My BMI is 43. I unfortunately didn't pursue it until this year and have wasted a lot of time. See if they have a Bariactric Surgery Department and call them. That's what I did to make sure. Good luck and keep me posted.

EverettM · July 16, 2007

I too have Kaiser and have been told they will not cover the surgery. I am really frustrated as well becasue it looks as if some people have been covered.

Vicki J · July 16, 2007

What I called the bariactric surgery unit directly when I was trying to find out. I, too, had the same frustrating run around when I was looking for answers. After going directly to them I had all the answers I needed. You should be able to find out the number through patient services or by just going online.

EverettM · July 18, 2007

Did you call the bariactric associated with Kaiser? I did call GW and got some information. I have to have a referral from Kaiser with authorization. I go to my primary care doctor and the end of the month and I am going to see what happens.

Vicki J · July 18, 2007

Yeah, out here we have a bariactric surgery unit at the Kaiser in So. San Francisco. I kept getting mixed messages from the people in patient services and so I just called the people who actually do the surgery. It was so releaving to have someone finally give me a definite answer. I was also able to ask some of the questions I had as to the process and stuff. They were really great. If your Kaiser sends you out to someone, I would find out who and call them. Even one of the doctors that I used to see had wrong information. When I talked to her about WLS she said that I wasn't big enough. LOL 260 lbs., 5'4", BMI 43, with co-morbitities and I wasn't big enough. Yeah, right.

So, I was looking into changing this fall to CalPers Choice when I found out that she was wrong. So I contacted my new PCP and was on my way.

Let me know if I can answer anymore questions. Good luck!

diamondntheruff · July 19, 2007

i am currently enrolled in the kaiser gastric bypass classes

we have to see a nutrionist, have a mental health exam and go to several classes for 5 mo...i was told lap band is covered by kaiser but it may be up to your Dr. they will see which surgey is best for you after you complete the 5mo..the nutrionist said you may stress lap band and i will b/c i don't want gastric...i am in the silver spring center...i go to a class there and 1 at holy cross

Vicki J · July 19, 2007

Diamondntheruff - Where are you from? It sounds like we have to do about the same thing. Maybe a little different.

diamondntheruff · July 20, 2007

i am from silver spring, md

iluvlongnecks · August 6, 2007

I went to my pcp 10 days ago and she has referred me to SF . She told me that it would be up to a surgeon if I was a candidate for LB surgery. Because my BMI is only 37 she told me that I wasn't. I reminded her that I have sever sleep apnea along with other health issues, back pain, swelling in feet,etc that she referred me to SF.

I know that you have to have a BMI of 40 to be approved, but I am praying that my other health issues will be considered. I can't image what I would feel like at a BMI of 40....God help me!

Vicki J · August 6, 2007

I have heard that you can get the surgery with a lower BMI in most places if you have other co-morbities. sleep apnea is one of them as well as back pain and other stuff. I would give it a good try and fight it to the end. I wouldn't be surprised if you get it.

I just went to my first 2 appointments after orientation in SF and they are really happy with my weight loss progress but I have to find out why my ferritin level is high. So she won't even give me a date to see the surgeon until we resolve this. Bummer. My next appointments are on the 24th for the Lifestyle class and my psych evaluation. Hopefully before then this other issue will be resolved.

From what I was told Friday it will be 3 months after the date you meet the surgeon until surgery. So prepare yourself for a long process but keep in mind that the outcome will be worth it.

iluvlongnecks · August 9, 2007

I got my letters from SF to get my blood work done and the form to have my dr order a EKG and chest x-ray. Went the following day and did my blood work and dropped off the form for my dr. I have already gotten the lab results back on my blood work and there don't seem to be any red flags. Now just waiting for the appt to take care of the other requests, but have time to take care of that before my scheduled oreintation, pysh eval., dietary eval.in SF on Sept 11th. (Trying not to be discouraged about the date 9/11). I know this doesn't mean I'm approved yet, but I pray that it does! I'm just not wanting to get my hopes up! This is where I could use some words of encouragement that this is going to happen. Keeping my fingers crossed! Would Kaiser really send me on all these test and all the way down to SF to deny me????

:cry

Vicki J · August 9, 2007

With over 900 people in the pipeline for just the SSF facility I sincerely doubt that they would have you go through all of this if they didn't think you should have the surgery. I went to my meeting with the dietician and Dr. Stiles on the 3rd and she told me they are just swamped. The time estimate for surgery after seeing the surgeon is 3 months now. They are fighting to get more OR time but they just aren't having much luck.

I don't get to see the surgeon until they find out why my ferritin levels are elevated. My Iron and liver function readings are normal. Only the ferritin is up. As soon as we get the go ahead from my PCP she will schedule the appointment with the surgeon.

I do have my psych evlauation and Lifestyles class on the 24th. Do you have your orientation, psych evaluation, meeting with Dr. Stiles and the dietician all on one day? If so, that was a real score. As far as 9/11 goes, if you don't add the year it's just another 9/11. We've had decades of them with no problems. If you let it bother you, you will be burdened the rest of your life every 9/11. I know that sounds harsh and I will remember the tragedy for the rest of my life but I refuse to let those b*****ds ruin my life by having me get depressed on 9/11. I am so proud of our country for banding together and not collapsing when this happened. Ok, off the soap box.

I've got my fingers crossed for you. I really believe you have one heck of a chance. Keep me posted.