Kaiser Oregon - Not Covered?

[petesmom 8]

Call the bariatric facility of your choice and have them verify your insurance coverage. They will be able to use the appropriate billing codes to determine coverage. We do that all of the time in the oxygen industry. Back in 2000 my sister had gastric bypass and in 2001 my mom had gastric bypass in Coos Bay. I had VSG 12 weeks ago in Mexico. I wasn't concerned about follow up care. I researched the crap out of my surgeon and found that he had a zero complication rate. I couldn't find anyone here like that. I also met 5 other people here locally that have been to him. Three of the five are in the medical field all they all said the it was the absolute cleanest facility that they have ever been in. I am in Southern Oregon.

Can I ask who your surgeon was in Mexico? I am researching now for surgery.

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[saoirse16 1]

Oh yes, I should've mentioned that I've been looking into Mexico too. But I'm concerned about post-op care/followups and getting that covered through Kaiser. Not sure how all that works? Especially if there's a serious issue some time down the road after surgery.

My hubby had his surgery in Mexico and OHSU Bariatric Center will provide him with medical care. It isn't as hard as people think to get a DR. I had my surgery in Coos Bay, and they took me on right away without a problem.

That's good to know! Thank you!

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[saoirse16 1]

Call the bariatric facility of your choice and have them verify your insurance coverage. They will be able to use the appropriate billing codes to determine coverage. We do that all of the time in the oxygen industry. Back in 2000 my sister had gastric bypass and in 2001 my mom had gastric bypass in Coos Bay. I had VSG 12 weeks ago in Mexico. I wasn't concerned about follow up care. I researched the crap out of my surgeon and found that he had a zero complication rate. I couldn't find anyone here like that. I also met 5 other people here locally that have been to him. Three of the five are in the medical field all they all said the it was the absolute cleanest facility that they have ever been in. I am in Southern Oregon.

Can I ask who your surgeon was in Mexico? I am researching now for surgery.

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I'm interested to know who the doctor is as well.

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[saoirse16 1]

It is definitely covered here in California. You could ask for a referral from your PCP to the bariatric program and then talk with the case manager. They might be able to help with verifying coverage.

Thank you! I will be scheduling my PCP appointment tomorrow. It seems that's the first step I should've taken to begin with. Whether I go through Kaiser or not, I'll need my doc to be on the same page and at least know what's going on with me.

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[Vinasu 621]

I don't know personally, but a lady I work with had hers done at Kaiser (Sunnyside in Portland). She was 43, close to 500 lbs, and had already had a heart attack and a stroke, so it was definitely medically necessary.

I don't know how she went about it, though.

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[highfunctioningfatman 2,675]

Call the bariatric facility of your choice and have them verify your insurance coverage. They will be able to use the appropriate billing codes to determine coverage. We do that all of the time in the oxygen industry. Back in 2000 my sister had gastric bypass and in 2001 my mom had gastric bypass in Coos Bay. I had VSG 12 weeks ago in Mexico. I wasn't concerned about follow up care. I researched the crap out of my surgeon and found that he had a zero complication rate. I couldn't find anyone here like that. I also met 5 other people here locally that have been to him. Three of the five are in the medical field all they all said the it was the absolute cleanest facility that they have ever been in. I am in Southern Oregon.

Can I ask who your surgeon was in Mexico? I am researching now for surgery.Sent from my XT1055 using the BariatricPal App

Call the bariatric facility of your choice and have them verify your insurance coverage. They will be able to use the appropriate billing codes to determine coverage. We do that all of the time in the oxygen industry. Back in 2000 my sister had gastric bypass and in 2001 my mom had gastric bypass in Coos Bay. I had VSG 12 weeks ago in Mexico. I wasn't concerned about follow up care. I researched the crap out of my surgeon and found that he had a zero complication rate. I couldn't find anyone here like that. I also met 5 other people here locally that have been to him. Three of the five are in the medical field all they all said the it was the absolute cleanest facility that they have ever been in. I am in Southern Oregon.

Can I ask who your surgeon was in Mexico? I am researching now for surgery.Sent from my XT1055 using the BariatricPal App

I'm interested to know who the doctor is as well. Sent from my iPhone using the BariatricPal App

Absolutely! My surgeon was Mauricio Gutierez at Trinity Medical. There is a coordinator in Grants Pass that I went through. I didn't care for the main coordinator. If you want the Coordinators information just send me a message.

[Daisy Day 91]

My BFF works in billing for Kaiser and it is covered if medically necessary, you have to be a certain BMI and have some health issues, she suggested to contact their weight loss services for more information.

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[saoirse16 1]

Thank you! I thought that too, especially with how our summary of coverage is worded, but Member Services was adamant that it wasn't covered, no matter what. I'll see if I can find the WL Svcs number - it's like they keep anything bariatric/weight loss-related hidden from the general public, and you need a decoder ring, a password and the super secret handshake to find it.

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[Aggiemae 739]

Coverage depends on your actual plan (Kaiser is not a "plan" it is a provider). If your coverage includes Bariatric, then it will be covered; if it excludes it, it will not be covered.

Exactly. Talk to your employer about changing your benefit package. December usually when plan changes happen so get on it right away.

Even if you paid the difference out of your own pocket it would likely cost less than self pay in Mexico and you would have the benefit of KP's pre and post op education programs and services.

[newmein2017 16]

I'm in CA and have Kaiser. It is covered under my plan, but I know others who had only partial coverage. I went on the kp.org site, logged in, and looked in the benefits section. It has a cost estimator for procedures. Try looking in there.

[saoirse16 1]

For anyone with the same questions that I had initially, it looks like so far, everything is going to proceed. I started with an office appt to discuss my obesity & health issues with my PCP & told her I was interested in bariatric surgery. Thanks to a new development of high BP over my last 3 appts that now requires meds (boo) and a few other things, I meet most of the medical requirements (my BMI is a few points above the "medically necessary" cutoff point), so that helps my request for surgery. My PCP is on board with the idea of bariatric surgery and has referred me to weight management. I start the 12-week classes in January & have my sleep study scheduled for that month too. So we'll see what happens...

[saoirse16 1]

Final update: Even if classified as medically necessary, it will not be covered. Bariatric surgery must be a part of your KP plan to have bariatric surgery performed, and not all KP plans have that option.

[Joann454 1,329]

Final update: Even if classified as medically necessary, it will not be covered. Bariatric surgery must be a part of your KP plan to have bariatric surgery performed, and not all KP plans have that option.

Well that just sucks. So sorry.
Will you do Mexico?

[emmybaby666 114]

Hmmm that's odd...out here in CA it's covered as long as your primary refers you and you meet all the medical criteria.

I had mine done through Fremont kaiser and it was covered. Just had to pay my deductible

[saoirse16 1]

Decided against Mexico. I'm self-paying at a non-KP hospital in OR.

And yeah, there are differences in the KP program by state - some states require that bariatric surgery is a covered service on all plans for that state (whether it is fully covered or partial varies by plan), some states don't have that requirement. Oregon does not require bariatric surgery to be a covered service. Sounds like CA is likely a state that does.