Hello all and help with Kaiser!!

[michelle vasey]

Hi there,

My name is Michelle and I am hoping to get bariatric surgery in the near future. I am 56 years young and have been heavy for 25 years.

I am a Kaiser member in Northern California. I have lost weight with the super low calorie shakes for 4 months and lost 40 lbs twice. Both times, I regained the weight within a year and a half.

I have gone to all the mandatory classes, psych evaluation and food logging Kaiser requires for bariatric surgery. They are also requiring me to lose 10 lbs. And ladies and gents, therein lies the rub. I am having so much trouble losing weight, which is why I am morbidly obese. If I could lose weight on my own, I would not need the surgery. I am getting frustrated and super depressed. I was so excited about the surgery but now, feel like about myself.

I am sorry to be so whiny on my first blog, but I could really use some help and support. I am hoping I will find it on this venue.

Thanks for reading,

Michelle

 

[galaxygrrl]

OK, we have lots of Kaiser No Cal people who had surgery and it worked. You need to do their program, but you will get surgery. Hang in there. Others will post their story. Surgery works. Make sure to get the DS.

 

[DianaCox]

You can request waiver of the stupid, pointless, not supported by medical evidence and expressly disclaimed by the ASMBS preop weight loss requirement. They will deny and we go straight to DMHC for appeal.

I’m tagging Larra who I work with on appeals. Welcome! We’ll get this done. What’s your BMI?

 

[southernlady]

Welcome michelle vasey

Loosing weight wasn't my issue...keeping it off was mine. And when I regained, it always brought friends.

 

[JackieOnLine]

hello & welcome, Michelle

 

[Larra]

Well, DianaCox is right about filing a grievance over the weight loss requirement...otoh, 10 pounds isn't a huge amount in the greater scheme of things. But, on yet another hand, you could also consider the DS instead of VSG. Some people do well with VSG, but others (a lot of others) do well initially but struggle with regain after a couple years when the sleeve stretches out, as it inevitably will. Success with a sleeve is possible, but requires a lot calorie, low fat, low carb diet for the rest of your life. That's a hefty commitment. The DS is much more forgiving, and while we do need to limit carbs, we can eat protein and fat freely and not worry about total calorie count. We do need more vitamins and minerals, and while this requirement is crucial, it isn't difficult. You get into a routine, much like brushing your teeth every day. It's certainly easier than the permanent low calorie, low fat, low carb diet.

In all likelihood, the folks at Kaiser have either not told you about the DS or have spoken negatively about it, because they don't do it and don't want to deal with it. But enough Kaiser patients have successfully appealed for the DS that they have a contract with Dr. Rabkin, a very experienced DS surgeon, for their patients who appeal successfully, and if your bmi is over 50 they won't even force you to go through the appeals process. Do your research and make very sure of what operation is best for you now, rather than having regrets post-op. We see new people looking to revise from lap band and vsg to DS all the time.

 

[michelle vasey]

Thanks everyone!! I feel better already. Now for my appeal

 

[galaxygrrl]

Since you are in the Bay Area, you might consider coming to Dr Rabin's group. It's so worth going too. You should learn about the DS. There are people there who have gone through the Kaiser system.

http://www.paclap.com/support/meetings-calendar.cfm

CALIFORNIA
San Francisco
Date: 2nd Wednesday of each month
Time: 6 PM - Simultaneous Informational Seminar and post-op meeting.
7 PM - General open meeting for both pre-op and post-op patients.
Place: Cafeteria at St. Mary's Hospital
450 Stanyan Street
San Francisco, CA 94117
Additional details: Parking is available at St. Mary's Hospital parking at the corner of Stanyan and Hayes Street.
For more information please call our office.

 

[michelle vasey]

Well, DianaCox is right about filing a grievance over the weight loss requirement...otoh, 10 pounds isn't a huge amount in the greater scheme of things. But, on yet another hand, you could also consider the DS instead of VSG. Some people do well with VSG, but others (a lot of others) do well initially but struggle with regain after a couple years when the sleeve stretches out, as it inevitably will. Success with a sleeve is possible, but requires a lot calorie, low fat, low carb diet for the rest of your life. That's a hefty commitment. The DS is much more forgiving, and while we do need to limit carbs, we can eat protein and fat freely and not worry about total calorie count. We do need more vitamins and minerals, and while this requirement is crucial, it isn't difficult. You get into a routine, much like brushing your teeth every day. It's certainly easier than the permanent low calorie, low fat, low carb diet.

In all likelihood, the folks at Kaiser have either not told you about the DS or have spoken negatively about it, because they don't do it and don't want to deal with it. But enough Kaiser patients have successfully appealed for the DS that they have a contract with Dr. Rabkin, a very experienced DS surgeon, for their patients who appeal successfully, and if your bmi is over 50 they won't even force you to go through the appeals process. Do your research and make very sure of what operation is best for you now, rather than having regrets post-op. We see new people looking to revise from lap band and vsg to DS all the time.

Hi Larra,

A doctor friend of mine who had both surgeries suggested getting the GS plus the DS. He also suggested getting my gall bladder removed at the same time.

Today I called the bariatric center at Kaiser Richmond to let them know I was having trouble losing the weight on my own. We will see what happens.

Thanks for reaching out and I appreciate your thoughts and information.

Michelle

 

[michelle vasey]

You can request waiver of the stupid, pointless, not supported by medical evidence and expressly disclaimed by the ASMBS preop weight loss requirement. They will deny and we go straight to DMHC for appeal.

I’m tagging Larra who I work with on appeals. Welcome! We’ll get this done. What’s your BMI?

Hey Diane,

My BMI is 38. I am 5'6" and 232 lbs and am 56 years old. My highest weight was 242 and my goal weight is 135 ish. So, I have about 100 lbs to lose. I think I am at an advantage if my BMI was over 50. I really don't want to compromise my health by getting there. I have a back disc issue from repetitive stress from gymnastic and competitive tennis. Once I had my first disc operation at 35, I really went to seed. I was probably around 180lbs at the time so I was on my way up. But I have been over 230 for 20 years. My body just holds on the this weight like it would die without it.

I have had some really bad days last week, beating myself up for not losing more weight to get to the surgery. I lost about 5 lbs over the last 6 weeks. And then it stopped. Crap, crap double crap.

As I told Larra, Gary spoke to me about getting the Sleeve and the DS plus having my gall bladder removed to prevent complications. I think this is for both short term weight loss as well as helping with keeping the weight off long term. Is that what you had done? I would love to hear your thoughts. I also need to find out what my next steps might be with Kaiser.

Thanks again for your time and attention,

Michelle

 

[Larra]

The sleeve is part of the DS. If you get a DS, you get a sleeve for moderate restriction, plus the re-routing of your small intestine to provide significant malabsorption, particularly of fat and somewhat for protein. It's the malabsorption that helps us the most for permanent weight loss. The sleeve helps with the initial weight loss, but less so for the long term. That's why so many people with sleeves look to have revisions (often much, much harder, if not impossible, to get covered by their insurance).

you will get no sympathy regarding your difficulty with your pre-op weight loss. Don't waste your time. Either file a grievance to waive the weight loss requirement, or request the DS, get a denial for that (if your bmi is less than 50), file your internal appeal for that and go from there. And start keeping a recordd of all contacts with Kaiser, including phone calls - name, job title, phone number, date, time, and summary of the conversation. This is not going to be an easy process.

 

[michelle vasey]

OK. So I guess I will request the DS. Might as well get it going. I will write an email and request it and see how is goes from there.

 

[michelle vasey]

I just sent the following:

Dear Dr. Mostaedi,
I have done a lot of research and feel the DS procedure will be the best long term solution for my weight loss and general health. Please consider this a formal request for the procedure at the earliest opportunity.
Thank you,
Michelle

 

[hilary1617]

Hi and welcome michelle vasey ! DS was one of the best decisions I ever made. I only regret not getting it sooner. Wishing you all the best.

 

[Larra]

You should get your official denial within a couple days (probably in the form of a reply email). Once you have that, you can file your internal appeal, which is a grievance. Kaiser then has 30 days to do their first and second level reviews and give you your final denial, and rest assured it will be a denial. At that point, you can go to external appeal through the DMHC (department of managed health care). I would recommend that you pm me and Diana before you submit your internal appeal and we'll give you a hand (though you did just fine with your email). To pm on this website, you start a "conversation" with us.