Kaiser SoCal

[TheUsualSuspect 0]

I have been trying to get a referral for a few years at Kaiser. My first PCP said the surgery doesn't work, switched PCP's, he refused to consider any weight loss options. I have a new PCP, he referred me to the Options Program, which gave the infamous Nestle shakes, shots, prepared meals, and pills as ways to loose weight, but not any surgical options. When I asked about surgical options, the Options Staff told me I needed a Bariatric Referral through Options. I asked my newest PCP, he said he gave me the referral. I called back to the Bariatrics section, they told me he had not. Anyone experience this? What did you do to fix it? I have tried all the Options presented, not interested in yo-yo dieting again.

Thank you.

Edited August 13, 2023 by TheUsualSuspect

[ChunkCat 737]

I don't have any experience with this insurance provider, hopefully someone else has. Have you called your insurance to ask what specific forms need to be submitted for the referral? Sometimes doctors think a blanket referral will cover things when it won't. Someone at the insurance company should be able to give you the specific info needed to get the ball rolling. Then you can take the form in to your doctor or send it on your portal and get things handled properly.

It is so frustrating, navigating the various insurers. Each one is different, even between regions in the same state! And they ALL make it SO hard to get the proper care. I wish you lots of luck in figuring this out. I'm really thankful my GP was happy to refer me, she has a sister who had bariatric surgery and did well so she's a huge fan!

[TheUsualSuspect 0]

Kaiser in SoCal does their Bariatrics in house, I have never had a referral where I had to fill anything out, the Dr does it electronically through the Chart Software they use. I am hoping someone knows how to get around it, seems at Kaiser the PCP does everything and they are the ones who determine what referrals you get, and what you don't get.

[RickM 1,753]

I don't know the specific hoops that need to jump through with Kaiser as I have never been with them, but your PCP is the primary gatekeeper, and they do have an incentive to keep things cheap, while keeping you alive, so the system does make it difficult. There should be some form of appeal process that lets you go around the PCP without endless doctor changes, and there is an ultimate appeal to the state department of managed healthcare to override insurer's decisions when appropriate, but you aren't there yet. My surgeon is (or was) contracted to Kaiser Norcal to do the DS for them when they lost those appeals, as they don't do that procedure in-house, but it is part of the accepted standards of care for obesity, so they are obliged to cover it (they just don't make it easy.) A bypass will be more straightforward to get as they do those in-house, but they're hoping that all the hoop-jumping will get you to lose enough weight that they don't have to do it! Good luck and perseverance.