Help! Kaiser or Anthem BC (in California)?

[prowinewoman 0]

I am starting a new job on Monday and have to make a decision by then about which health insurance to pick, and I have narrowed it down to Kaiser or Anthem BC. I am hoping to have gastric sleeve surgery this summer. The Kaiser plan (after my employer contribution) will cost me $90/month but has a $6,500 out-of-pocket maximum, whereas the Anthem will cost me $190/month but only has a $3,000 out-of-pocket maximum. It looks like their coverage and requirements for the surgery are about the same but sometimes it's hard to know until the process is started. I can always choose a less expensive plan next year during the open enrollment after my surgery has (hopefully!) been completed.

Wondering if anyone can share their experiences with me if you have either of these insurances. The thought of a "one-stop-shop" for Kaiser sounds appealing, but not sure if it's worth the extra out-of-pocket expense.

Thanks in advance!

Edited January 21, 2015 by prowinewoman

[LivingFree! 478]

You don't say which Kaiser you would be using. I have been a bariatric patient at Kaiser/Fontana for four years and can tell you that their Bariatric Program is absolutely amazing. You probably would not be able to find more complete care anywhere else in southern California (if you are in So CA). This Program sets you up for long-term succcess, (as long as you are ready to do the hard work that it takes to embark on the WLS adventure). Kaiser's bariatric program does not just do the surgery and then send you on your merry way. They prepare you well in advance of your surgery with intense education, and provide long-term support after your surgery as well. They WANT YOU TO SUCCEED! Sometimes when you are faced with making such a life-changing decision such as weight loss surgery is, maybe the differences in your out-of pocket expenses over what the quality of your care might help you decide. Hope some people post here who have experienced both insurance plans to help you compare.

Good luck with your decision.

[dupexi 26]

I had Kaiser and I thought it was terrible. I have Hashimoto's and my primary care gave me the runaround when I asked to see an endocrinologist because I believed she was under-treating me. I left for Anthem BC, and haven't had any issues with seeing whatever specialist I need.

I had Anthem BC for the surgery, and paid $1400 out of pocket, when the total bill was $113K. Also, it was the easiest application. I just had to be over 40 BMI, did the psych consult, talked to the nut on the phone. My surgeon sent in the request. No 6 month physician monitored diet, no mandatory waiting period. They did require a center of excellence hospital which probably inflated the bill.

[jess9395 5,450]

My anthem blue cross exp was similar

[prowinewoman 0]

Thanks for your feedback everyone (and congrats to you all on your success!) I've had Anthem BC for the last 7 years and have been overall happy with it, but LivingFree you have some good points about setting you up for long-term success. (I live in the Bay Area, and the Kaiser Richmond facility would be the closest to me).

But, the idea of not having to deal with a waiting period or dr-supervised diet is very enticing! I've been thinking about this surgery for years (joined this site in 2009), and have tried many other non-surgery evenues in the meantime and I have decided that this is the route I am meant to take. It would be nice to jump in and get started right away.

Tough decision, I have a lot to consider by Monday!

[Tauret 3]

Keep in mind that Anthem changed their policy as of 1/13/15 to require a 6-month diet. I haven't been able to figure whether or not they require actual physician supervision or just documentation reviewed by the physician. I'm waiting now on my benefits coordinator to find out for me. That said, I have a $2500 deductible HSA that covers at 100% after that.

http://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm

[OldMomOf3 52]

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Edited February 2, 2015 by MomOf3InOC

[Tauret 3]

Woah that could be really useful info, thanks. I'd like to see the documentation backing that up, in case I have to fight.

I think it's completely ridiculous since in their own policy statement, they link to this position statement by the ASMBS which says there is absolutely no medical evidence that those diets are helpful in any way.

[Redefined 37]

I was band revision patient (done with Blue Shield). I went in to see the Kaiser doctor (So Cal) on the 15th of December and had my surgery on 1.5.15. The process was easy and smooth...

[The Candidate 3,215]

I'm Kaiser Southern Cal San Diego. I'm currently going through their required Options program, which in my area is six months (24 weeks) of classes. Other areas of California only require three months, so there is a lot of variance depending on where you are. In the beginning it seems like a long time, but it really does go fast. I started my process in late August. My actual classes didn't start until Nov and go through mid May. And after graduation there are still steps I have to complete before I get to surgery.

But one thing I've found is that the majority of people who go through the program are glad they did in the end. Kaiser really tries to prepare you both physically and mentally for what will amount to a whole new way of life. Yes, I've done my research to the nth degree and you probably have too, but there's always more to learn to truly make an informed decision.

I just finished #8 of my 24 classes and it's true, the time does fly by. Overall, It's a worthwhile program in my opinion. Good luck on your journey!

Edited January 24, 2015 by The Candidate

[LivingFree! 478]

prowinewoman,

One more thing I'd like to add--no matter which insurance carrier you choose, some of the requirements they have are for YOUR BENEFIT, as ridiculous as some of them may sound. The 6 month supervised diet that BC requires is to prepare you to GET REAL about drastically changing your eating habits and lifestyle for life. We all "intellectually" know we have to do that going into this, but "knowing it" and being emotionally ready to "do it" are two entirely different things.

And yes, as The Candidate said, some Kaisers still require 24 weeks of Options classes; most are now only 12 weeks though. As you're finishing up the classes you would be having a psych eval appt with a Kaiser therapist and attend one support group and then your surgery date would be arranged.

Just please think about not wanting to be in such a HURRY to get to your actual surgery. Remember that WLS is a PROCESS. It is not just about the operation and dropping the pounds. We are WLS patients for life, and we have the disease of obesity for life.

It feels really good at four years out from my surgery that I know I've put in the HARD WORK to change my horrible old lifetime of bad and unhealthy habits and now food does not have power over me any more. I have the power over my food, and IT IS JUST FOOD and I use it as fuel and medicine for my body.

Hope this helps . . .good luck!

[Tauret 3]

Sorry, nope. You're never going to convince me that a) any insurance company actually has my best interests, rather than their bottom line, at heart or that a board of policymakers giving a general sweeping statement is more capable of making a sound medical decision about my health than my well-qualified surgeon who has taken the time to speak with me and knows the particulars of my personal situation and his practice and abilities. Furthermore, as I mentioned, the American Society for Metabolic and Bariatric Surgery's position statement indicates there is absolutely no medical basis for these requirements, that they don't improve outcomes, but they DO frequently cause patients to drop out and thus be denied a potentially lifesaving surgery.

[DoOverWLS 4]

I was band revision patient (done with Blue Shield). I went in to see the Kaiser doctor (So Cal) on the 15th of December and had my surgery on 1.5.15. The process was easy and smooth...

Was the 12/15 date with the surgeon or your KP PCP? I have my PCP appt tomorrow (2/23). I'm looking to do a revision of my lap band (cash pay outside KP) to sleeve. I can only hope my timetable is as quick as yours.

[Redefined 37]

I was seen by the bariatric doctor without seeing pcp as I'd had wls surgery previously

[DoOverWLS 4]

I was seen by the bariatric doctor without seeing pcp as I'd had wls surgery previously

Wow! My PCP put in the referral today and I have a connection in Health Ed to get an idea if I'll have to go through the classes. It depends on what my PCP entered for the referral and how they feel about why I'm making the decision for the revision. I'll take whatever path they lay out. I want it done so that I can have a do-over and finally have some success.

One more question... Did you have you have your procedure at West LA (Cadillac)?