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Anyone with Kaiser Northern Calif with Covered California?



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After having hit a brick wall with Blue Shield (if your Blue Shield coverage is through covered california, you are limited to doctors/facilities in Southern California, and the closest one for me is 6 hrs away), I am considering switching to Kaiser during the upcoming open enrollment. If you've had the procedure approved and you're with Kaiser Northern Calif, would you recommend them? Are their requirements so strict that a lot of people get declined? I had read somewhere that they require that you've been morbidly obese for at least 2 of the last 5 years. Is there somewhere I can find a list of the co-morbidities they consider? I have high cholesterol, fatty liver and stage 4 osteoarthritis and am right at 40 BMI, but they say that they will consider 35-39.9 BMIs if they have serious obesity-related health issues "such as diabetes, coronary heart disease or severe sleep apnea." So I feel like I need to gain a couple of lbs. (which I'm good at) to have a little cushion. I can't get info on the Kaiser website unless I am a member. Bottom line is, I don't want to switch to Kaiser only to discover that something will disqualify me. I see some specialists I'd prefer not to give up, so would hate to be stuck with Kaiser if I can't get approved for the surgery through them (or they don't cover it if you get it through covered california. )

Has anyone here with covered california navigated this maze?

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I have Kaiser in Washington State. I had to change Kaiser plans to one that will cover WLS. Most likely you will have to call a representative at Kaiser in northern CA and ask which plan covers it. I had to have a couple of conditions related to obesity. sleep apnea is one it seems they automatically diagnose anyone that is 5 lbs over weight with. I take a small dose of BP medication. Oh, another one like sleep apnea that they really can't disprove is acid reflux. Get a doctor to prescribe some acid reflux meds. I only had the sleep apnea and high blood pressure diagnosis along with my BMI over 40 and it was approved. There's other comorbidities like diabetes and it might be different in every case as far as insurance acceptance but hopefully this will give you an idea of what to expect. Good luck!

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Thanks for taking the time to respond. I've never had blood pressure problems, but if they were to slap a cuff on while I was talking to the know-nothing insurance people, it would be plenty high enough to qualify! But seriously, good to know the ins and outs of sleep apnea and acid reflux After looking through the symptoms for each, it looks like I could have both. I'll talk to my PCP at my next appointment and get a scrip for an acid reflux med. and a cpap mask.

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I agree, call and chat with a membership rep about the plans that cover it. I used Kaiser in So cal, but my mom had a Kaiser surgeon do her sleeve surgery years ago in SF. Honestly, both of us have had incredible experiences and great care.

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    • LeighaTR

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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