Hello my name is Maria. I am trying to get duodenal switch surgery referral through Kaiser. My surgeon, Dr. Dutta, has said that he will no longer refer patients out for this surgery even though I am a perfect candidate. I am looking to see if anybody has any information that they can give me to help me file a grievance with them. Thank you
DS with Kaiser
- Thread starter MariaMZ
- Start date
Hi Maria
hilary1617
First time at the rodeo.
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aaa
Well-Known Member
Hi Maria. I think I met you at the meeting.
There are a couple of insurance experts here. I hope they can provide some guidance.
Yes! My surgeon just recently referred my best friend for the DS surgery. But now he is saying he is no longer referring any patients out because there's too many complications.
ShrinkingMyTiara
Well-Known Member
Hi Maria, welcome!! Sorry you are having issues with your insurance. Can you see another doctor that will give you a referral? It seems this guy is going by his preference instead of meeting his patients needs. I'd find a more amenable doctor.
sorry to say your doctor doesn't seem to have good information.
DianaCox
who else is an insurance expert here? I should know this!
galaxygrrl
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I would file a complaint with Kaiser first, saying your surgeon is refusing to refer you for a standard of care surgery that you otherwise are qualified for, that Kaiser does not perform, making an unfounded, unsubstantiated claim, which in any case is NOT true, based on your research, regarding Dr. Rabkin in SF, one of the most respected DS surgeons in the world, and to whom NorCal Kaiser patients have been referred for years when they want the DS procedure.
My assumption is you will receive another denial, at which point you can appeal to the CA Dept of Managed Health Care (hereinafter DMHC).
In the meantime, ask them to give you Mounjaro (if you’re diabetic or pre-diabetic), or Zepbound, which is the same drug, approved last week for treatment of obesity. It’s over $1000/mo, and if it works, it might be an alternative to surgery (I’m old and on Medicare, which currently excludes all obesity medication, but I’m going to get [unloved] involved in promoting the current legislation to change Medicare law on this subject - I want to take it to see if I can lose 40 lbs or so.)
My assumption is you will receive another denial, at which point you can appeal to the CA Dept of Managed Health Care (hereinafter DMHC).
In the meantime, ask them to give you Mounjaro (if you’re diabetic or pre-diabetic), or Zepbound, which is the same drug, approved last week for treatment of obesity. It’s over $1000/mo, and if it works, it might be an alternative to surgery (I’m old and on Medicare, which currently excludes all obesity medication, but I’m going to get [unloved] involved in promoting the current legislation to change Medicare law on this subject - I want to take it to see if I can lose 40 lbs or so.)
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Spiky Bugger
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I can’t imagine you’re getting unloved. Involved, maybe, but not unloved…lol
Spiky Bugger
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Also, per an AARP article I just read, Medicare has decided to cover some VERY EXPENSIVE Alzheimer’s/dementia drugs…and I can’t see how doing so would save them a dime.
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galaxygrrl
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Good news is there is a coupon for both drugs. It brought the price down from $1000 a month to $500 a month.
So, I'm a DS, 7 years out. I bounced back about 20 pounds. Then in July I started Mounjuro ( I had diabetes before surgery, so it was in my charts), I exercised a lot and I just did not want to eat much. But in 3 months, I lost 25 pounds. It shocked the heck out of me. I went from 150 to 125. Lots of people have side effects for the first month, but I had none.
I was super scared I'd gain the weight back, but I cut out all sugar and limited carbs and 7 weeks out, I'm still 125.
So definitely get Mounjuro or Zebound. Here are the coupons. If you don't have insurance coverage for this, it's brings the cost down to $500
Two things to note:
(1) I think Kasier has a BMI requirement for the DS. So, if you lose some weight, be careful not to go below that.
(2) I love the new weight loss drugs, but they are not a replacement for the DS. You need to take them forever for them to work forever. Every study done say people who go off them gain weight back. Also, the average weight loss on Mounjuro is around 20% of your body weight.
Here are the coupons.
Savings Card, Cost & Coverage Support | Zepbound (tirzepatide)
Understand your cost and coverage options for Zepbound. Learn more about the Zepbound Savings Card and LillyDirect, an online pharmacy services option.
Savings & Resources | Mounjaro® (tirzepatide)
You may be eligible to save on Mounjaro®. Find support resources and information about the savings card for eligible patients and LillyDirect.
www.mounjaro.com
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galaxygrrl
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Oh here is my favorite article on the new weight loss drugs from the NY Times. https://www.nytimes.com/2023/06/21/well/eat/ozempic-food-noise.html
People on Drugs Like Ozempic Say Their ‘Food Noise’ Has Disappeared
Until she started taking the weight loss drug Wegovy, Staci Klemmer’s days revolved around food. When she woke up, she plotted out what she would eat; as soon as she had lunch, she thought about dinner. After leaving work as a high school teacher in Bucks County, Pa., she would often drive to Taco Bell or McDonald’s to quell what she called a “24/7 chatter” in the back of her mind. Even when she was full, she wanted to eat.
Almost immediately after Ms. Klemmer’s first dose of medication in February, she was hit with side effects: acid reflux, constipation, queasiness, fatigue. But, she said, it was like a switch flipped in her brain — the “food noise” went silent.
“I don’t think about tacos all the time anymore,” Ms. Klemmer, 57, said. “I don’t have cravings anymore. At all. It’s the weirdest thing.”
Dr. Andrew Kraftson, a clinical associate professor at Michigan Medicine, said that over his 13 years as an obesity medicine specialist, people he treated would often say they couldn’t stop thinking about food. So when he started prescribing Wegovy and Ozempic, a diabetes medication that contains the same compound, and patients began to use the term food noise, saying it had disappeared, he knew exactly what they meant.
Advertisement
As interest has intensified around Ozempic and other injectable diabetes medications like Mounjaro, which works in similar ways, that term has gained traction. Videos related to the subject “food noise explained” have been viewed 1.8 billion times on TikTok. And some of the people who have managed to get their hands on these medications — despite persistent shortages and list prices that can near or surpass a thousand dollars — have shared stories on social media about their experiences.
When food noise fades
Wendy Gantt, 56, said she first heard the term food noise on TikTok, where she had also learned about Mounjaro. She found a telehealth platform and received a prescription within a few hours. She can remember the first day she started taking it last summer. “It was like a sense of freedom from that loop of, ‘What am I going to eat? I’m never full; there’s not enough. What can I snack on?’” she said. “It’s like someone took an eraser to it.”
For some, the shortages of these medications have provided a test case, a way to see their lives with and without food noise. Kelsey Ryan, 35, an insurance broker in Canandaigua, N.Y., hasn’t been able to fill her Ozempic prescription for the last few weeks, and the noise has crept back in. It’s not just the pull of soft-serve each day, she said. Food noise, to Ms. Ryan, also means a range of other food-related thoughts: internal negotiations about whether to eat in front of other people, wondering if they’ll judge her for eating fried chicken or if ordering a salad makes it look like she’s trying too hard. Ozempic is more of a way to silence the food noise than anything else, she said.
“It’s a tool,” she said. “It’s not like a magic drug that’s giving people an easy way out.”
What causes food noise?
There is no clinical definition for food noise, but the experts and patients interviewed for this article generally agreed it was shorthand for constant rumination about food. Some researchers associate the concept with “hedonic hunger,” an intense preoccupation with eating food for the purpose of pleasure, and noted that it could also be a component of binge eating disorder, which is common but often misunderstood.
Obesity medicine specialists have tried to better understand why a person may ruminate about food for some time, said Dr. Robert Gabbay, chief scientific and medical officer of the American Diabetes Association. “It just seems to be that some people are a little more wired this way,” he said. Obsessive rumination about food is most likely a result of genetic factors as well as environmental exposure and learned habits, said Dr. Janice Jin Hwang, chief of the division of endocrinology and metabolism at the University of North Carolina School of Medicine.
Why some people can shake off the impulse to eat, and other people stay mired in thoughts about food, is “the million-dollar question,” Dr. Hwang said.
How does medication suppress food noise?
The active ingredient in Ozempic and Wegovy is semaglutide, a compound that affects the areas in the brain that regulate appetite, Dr. Gabbay said; it also prompts the stomach to empty more slowly, making people taking the medication feel fuller faster and for longer. That satiation itself could blunt food noise, he said.
There’s another theoretical framework for why Ozempic might quash food noise: Semaglutide activates receptors for a hormone called GLP-1. Studies in animals have shown those receptors are found in cells in regions of the brain that are particularly important for motivation and reward, pointing to one potential way semaglutide could influence cravings and desires. It’s possible, although not proven, that the same happens in humans, Dr. Hwang said, which could explain why people taking the medication sometimes report that the food (and, in some cases, alcohol) they used to crave no longer gives them joy.
Researchers are continuing to investigate how semaglutide works, how it may influence aspects of the brain like food noise and the potential it has for other uses, like treating addiction.
Ms. Klemmer said she worried about the potential long-term side effects of a medication she might be on for the rest of her life. But she thinks the trade-off — the end of food noise — is worth it. “It’s worth every bad side effect that I’d have to go through to have what I feel now,” she said: “not caring about food.”
People on Drugs Like Ozempic Say Their ‘Food Noise’ Has Disappeared
Until she started taking the weight loss drug Wegovy, Staci Klemmer’s days revolved around food. When she woke up, she plotted out what she would eat; as soon as she had lunch, she thought about dinner. After leaving work as a high school teacher in Bucks County, Pa., she would often drive to Taco Bell or McDonald’s to quell what she called a “24/7 chatter” in the back of her mind. Even when she was full, she wanted to eat.
Almost immediately after Ms. Klemmer’s first dose of medication in February, she was hit with side effects: acid reflux, constipation, queasiness, fatigue. But, she said, it was like a switch flipped in her brain — the “food noise” went silent.
“I don’t think about tacos all the time anymore,” Ms. Klemmer, 57, said. “I don’t have cravings anymore. At all. It’s the weirdest thing.”
Dr. Andrew Kraftson, a clinical associate professor at Michigan Medicine, said that over his 13 years as an obesity medicine specialist, people he treated would often say they couldn’t stop thinking about food. So when he started prescribing Wegovy and Ozempic, a diabetes medication that contains the same compound, and patients began to use the term food noise, saying it had disappeared, he knew exactly what they meant.
Advertisement
As interest has intensified around Ozempic and other injectable diabetes medications like Mounjaro, which works in similar ways, that term has gained traction. Videos related to the subject “food noise explained” have been viewed 1.8 billion times on TikTok. And some of the people who have managed to get their hands on these medications — despite persistent shortages and list prices that can near or surpass a thousand dollars — have shared stories on social media about their experiences.
When food noise fades
Wendy Gantt, 56, said she first heard the term food noise on TikTok, where she had also learned about Mounjaro. She found a telehealth platform and received a prescription within a few hours. She can remember the first day she started taking it last summer. “It was like a sense of freedom from that loop of, ‘What am I going to eat? I’m never full; there’s not enough. What can I snack on?’” she said. “It’s like someone took an eraser to it.”
For some, the shortages of these medications have provided a test case, a way to see their lives with and without food noise. Kelsey Ryan, 35, an insurance broker in Canandaigua, N.Y., hasn’t been able to fill her Ozempic prescription for the last few weeks, and the noise has crept back in. It’s not just the pull of soft-serve each day, she said. Food noise, to Ms. Ryan, also means a range of other food-related thoughts: internal negotiations about whether to eat in front of other people, wondering if they’ll judge her for eating fried chicken or if ordering a salad makes it look like she’s trying too hard. Ozempic is more of a way to silence the food noise than anything else, she said.
“It’s a tool,” she said. “It’s not like a magic drug that’s giving people an easy way out.”
What causes food noise?
There is no clinical definition for food noise, but the experts and patients interviewed for this article generally agreed it was shorthand for constant rumination about food. Some researchers associate the concept with “hedonic hunger,” an intense preoccupation with eating food for the purpose of pleasure, and noted that it could also be a component of binge eating disorder, which is common but often misunderstood.
Obesity medicine specialists have tried to better understand why a person may ruminate about food for some time, said Dr. Robert Gabbay, chief scientific and medical officer of the American Diabetes Association. “It just seems to be that some people are a little more wired this way,” he said. Obsessive rumination about food is most likely a result of genetic factors as well as environmental exposure and learned habits, said Dr. Janice Jin Hwang, chief of the division of endocrinology and metabolism at the University of North Carolina School of Medicine.
Why some people can shake off the impulse to eat, and other people stay mired in thoughts about food, is “the million-dollar question,” Dr. Hwang said.
How does medication suppress food noise?
The active ingredient in Ozempic and Wegovy is semaglutide, a compound that affects the areas in the brain that regulate appetite, Dr. Gabbay said; it also prompts the stomach to empty more slowly, making people taking the medication feel fuller faster and for longer. That satiation itself could blunt food noise, he said.
There’s another theoretical framework for why Ozempic might quash food noise: Semaglutide activates receptors for a hormone called GLP-1. Studies in animals have shown those receptors are found in cells in regions of the brain that are particularly important for motivation and reward, pointing to one potential way semaglutide could influence cravings and desires. It’s possible, although not proven, that the same happens in humans, Dr. Hwang said, which could explain why people taking the medication sometimes report that the food (and, in some cases, alcohol) they used to crave no longer gives them joy.
Researchers are continuing to investigate how semaglutide works, how it may influence aspects of the brain like food noise and the potential it has for other uses, like treating addiction.
Ms. Klemmer said she worried about the potential long-term side effects of a medication she might be on for the rest of her life. But she thinks the trade-off — the end of food noise — is worth it. “It’s worth every bad side effect that I’d have to go through to have what I feel now,” she said: “not caring about food.”
aaa
Well-Known Member
That’s why I loved Phen-Fen. No food noise.
