Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Kaiser Questions



Recommended Posts

Yes, I have Kaiser of Colorado and their plan only covers 50%. What's really frustrating is that I used their estimator which states it uses my plan information to estimate, which I why I started the process. And then they turn around and say 50%. is all they cover and the entire bill is $28,000; so my share would be $14,000, and that's just for the surgery. I still have deductibles for speciality appointments with the doctor, mental health and the classes leading up to the surgery.

It just seems crazy...and I just need to research and see if there is something I am missing.

Thank God I found this post! I am in the exact same boat as you. I am also with Kaiser Colorado with a 50% benefit for bariatric. It is refreshing to hear you were quoted the same amount as me for Saint Joseph's, including the deposit amount. This issue also came up with another girl in Colorado but her plan pays less and they told her she has to pay almost $7k before the surgery which is absolutely ridiculous. Part of my issue is that I am starting the six week classes on October 27th and I have been on this journey for almost a year because I had to lower my bmi by 10%. Therefore I am completely invested with Kaiser and do like my services with them. My open enrollment is coming up in Nov and I may have to switch to Aetna which has an out of pocket max of $3k because they consider the surgery medically necessary when approved. The issue with Kaiser is bariatric pays completely different than other inpatient stays. I would normally have a 10% copayment up to $1500 OOP max. Bariatric coverage states the OOP max does not apply. I read somewhere on here that if you have to have another procedure such as a hernia repair that this benefit would kick in first for facility and anesthesia so you would only have to the additional cost for the surgery only which is only around $1500 for kaisers contracted price at 50%. I am tempted to see if I need a hernia repair just to test this theory. I asked both Kaiser and st Joe about financing and was told they consider the procedure elective so they likely would not offer this benefit for the surgery but I Still plan to try. I too was mislead by the online estimator and was told 1500 max OOP. I called into the regular benefits center before i even started and they confirmed this amount so imagine my surprise when I recently received this new figure from the counselor. I am looking into every option I can before open enrollment ends on Nov 15. I plan to call today to see is self pay would be cheaper and to ask if Kaiser if I can switch to the Colorado Springs area which is probably cheaper. Anyhow I will let you know if anything changes.

Share this post


Link to post
Share on other sites

You know I forgot what we did for part of the money when hubby went to Mexico for his WLS. My KIA SOUL had been paid off for quite some time, so we took out a $6,000 loan and used my KIA as collateral. So it might be something to think about.

Share this post


Link to post
Share on other sites

Yes, I have Kaiser of Colorado and their plan only covers 50%. What's really frustrating is that I used their estimator which states it uses my plan information to estimate, which I why I started the process. And then they turn around and say 50%. is all they cover and the entire bill is $28,000; so my share would be $14,000, and that's just for the surgery. I still have deductibles for speciality appointments with the doctor, mental health and the classes leading up to the surgery.

It just seems crazy...and I just need to research and see if there is something I am missing.

Thank God I found this post! I am in the exact same boat as you. I am also with Kaiser Colorado with a 50% benefit for bariatric. It is refreshing to hear you were quoted the same amount as me for Saint Joseph's, including the deposit amount. This issue also came up with another girl in Colorado but her plan pays less and they told her she has to pay almost $7k before the surgery which is absolutely ridiculous. Part of my issue is that I am starting the six week classes on October 27th and I have been on this journey for almost a year because I had to lower my bmi by 10%. Therefore I am completely invested with Kaiser and do like my services with them. My open enrollment is coming up in Nov and I may have to switch to Aetna which has an out of pocket max of $3k because they consider the surgery medically necessary when approved. The issue with Kaiser is bariatric pays completely different than other inpatient stays. I would normally have a 10% copayment up to $1500 OOP max. Bariatric coverage states the OOP max does not apply. I read somewhere on here that if you have to have another procedure such as a hernia repair that this benefit would kick in first for facility and anesthesia so you would only have to the additional cost for the surgery only which is only around $1500 for kaisers contracted price at 50%. I am tempted to see if I need a hernia repair just to test this theory. I asked both Kaiser and st Joe about financing and was told they consider the procedure elective so they likely would not offer this benefit for the surgery but I Still plan to try. I too was mislead by the online estimator and was told 1500 max OOP. I called into the regular benefits center before i even started and they confirmed this amount so imagine my surprise when I recently received this new figure from the counselor. I am looking into every option I can before open enrollment ends on Nov 15. I plan to call today to see is self pay would be cheaper and to ask if Kaiser if I can switch to the Colorado Springs area which is probably cheaper. Anyhow I will let you know if anything changes.

I am so glad you replied. I am just at such a loss and the finance counselors at Kaiser just keep saying "Yes, we've heard this problem before and we're working on it." I just don't understand how Kaiser thinks. I'm at a BMI over 50, this isn't just so I can look pretty. This is to avoid serious health risks by continuing to carry around all this weight. Weight I gathered over time but continue to yo-yo on and off again. Even with watching what I eat and exercising as much as I can, I just keep bouncing between 320 and 255. This isn't elective, and I don't understand how they can continue on saying that it is.

I may have to look outside my employer medical. They only offer Kaiser or United Healthcare. Unless United Healthcare offers better coverage, I may have to go back to the drawing board.

I wish you the best of luck! No matter what you do, I'll be cheering you on =D

Share this post


Link to post
Share on other sites

My hubby has United HealthCare thru ARRP and they covered WLS. Good Luck

Share this post


Link to post
Share on other sites

Avarine--- Yes it really sucks. I am starting to come to terms with switching over to Aetna since paying the $338 for 18 mths is simply too much on top of all the other costs. I am still going through with the Kaiser process since it will meet the Aetna requirements. Potential setbacks are that the surgeon could require additional tests which Kaiser does not require any test. Definitely keep me posted!

Share this post


Link to post
Share on other sites

Sorry to hear that Avarine. I have Kaiser in the Northwest (Oregon/Washington), I actually work for them, but here in our region, it is covered. I just had my $5 copays for office visits. I wish you luck in figuring this out! You will find a way, don't give up!

Share this post


Link to post
Share on other sites

Ok here is an update. As is of 2017 all Kaiser Colorado plans now have a state requirement that bariatric surgery deemed as medically necessary must apply to the deductible and out of pocket max. Therefore you oop Max is the most you will pay. I called them yesterday and they confirmed this. So $1500 will be my max. Hopefully this helps you Avarine since the $14k is no longer an issue for us.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×