I'm new here @BF, but not new to WLS. I had RNY in October 2010. I lost about 80 lbs, and I have been gaining for the past few years. I am looking for guidance in starting down the path of revision to DS (which wasn't mentioned as an option), with Kaiser...which I have read is going to be a battle to the death.
Hello
- Thread starter squisheez
- Start date
Welcome @squisheez
Only two options in your neck of the woods (assuming your Kaiser is located on the west coast) and those are the two located in California: http://bariatricfacts.org/threads/current-list-of-known-rny-or-lapband-to-ds-surgeons.1403/
You will need your Evidence of Coverage (typically 100ish pages but can greatly exceed that). Then get with @DianaCox and @Larra for specific help.
Only two options in your neck of the woods (assuming your Kaiser is located on the west coast) and those are the two located in California: http://bariatricfacts.org/threads/current-list-of-known-rny-or-lapband-to-ds-surgeons.1403/
You will need your Evidence of Coverage (typically 100ish pages but can greatly exceed that). Then get with @DianaCox and @Larra for specific help.
Is the EOC to see whether WLS is covered in my plan? Do I get it from Kaiser? Also I have open enrollment in November, I could change to Western Health Advantage, if they more likely to approve a revision.
Larra
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- Dec 31, 2013
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Hi again!
Yes, get your EOC. Kaiser is extremely negative about all revisions. You can start a pm (called a conversation around here) with me and with @DianaCox so we can communicate more easily. It will be necessary for you to first get a referral into the bariatric surgery program and go through all the steps to get to a surgeon and get a denial (virtually guaranteed regardless of your circumstances) and then start appeals. You will need to make a case for medical necessity, and even then you will get nothing but denials from Kaiser. You will then go to external appeal.
If you are successful (which is not guaranteed) you will be sent to Dr. John Rabkin of Pacific Laparoscopy in San Francisco, as Kaiser has a contract with him. This is a good thing, because he's an excellent and very experienced DS surgeon who does these complex revisions, which many DS surgeons don't do. If you live in the Bay Area, you could get involved with his support groups, which are free and open to anyone and very worthwhile.
Yes, get your EOC. Kaiser is extremely negative about all revisions. You can start a pm (called a conversation around here) with me and with @DianaCox so we can communicate more easily. It will be necessary for you to first get a referral into the bariatric surgery program and go through all the steps to get to a surgeon and get a denial (virtually guaranteed regardless of your circumstances) and then start appeals. You will need to make a case for medical necessity, and even then you will get nothing but denials from Kaiser. You will then go to external appeal.
If you are successful (which is not guaranteed) you will be sent to Dr. John Rabkin of Pacific Laparoscopy in San Francisco, as Kaiser has a contract with him. This is a good thing, because he's an excellent and very experienced DS surgeon who does these complex revisions, which many DS surgeons don't do. If you live in the Bay Area, you could get involved with his support groups, which are free and open to anyone and very worthwhile.
Larra
Well-Known Member
- Joined
- Dec 31, 2013
- Messages
- 3,521
The EOC has all the details about what is covered and under what criteria.
I have never heard of Western Health Advantage. If you can, see if you can find out about their bariatric surgery coverage. Remember that coverage for a revision of any kind if often different from coverage for a primary bariatric surgery.
I have never heard of Western Health Advantage. If you can, see if you can find out about their bariatric surgery coverage. Remember that coverage for a revision of any kind if often different from coverage for a primary bariatric surgery.
Where do I get my EOC? Do I get it from the administration office at Kaiser? I checked all over on my Kaiser page looking for it, even did a search for it.
