Hello all and help with Kaiser!!

[michelle vasey]

You were soooo right. I am again requesting it from my Kaiser email and requesting it get bumped up to his superviser. I should have my denial shortly. In the mean time, on with healthy eating!!

HAPPY FOURTH OF JULY EVERYONE!!

 

[galaxygrrl]

Michelle,

Come and meet us all at Dr. Rabkin's group next week. Here is the thing I learned by going to the groups. The DSers are happy. They are so happy. The battle of the budge is basically done. You can eat a fair amount and you wont gain your weight back.

The trade off is you need vitamins.

The RNY group told me dumping was my friend the Sleeve group was not that skinny. That is what did it for me. The Drs are not the ones that need to live with the surgery. You do.

 

[michelle vasey]

I really want to but have to work that day. What time is the meeting?

 

[michelle vasey]

Hi everyone,

I have been on holiday with my family at the Oregon coast. I am looking forward to meeting many of you at the next meeting. In the mean time, Kaiser has set up a second telephone consultation with another bariatric surgeon, Dr. Dutta at 3pm tomorrow. I think someone mentioned he is the regional chair.

I am going to tell him the same thing as before. I have done the research about all the standard of care procedures and am requesting the DS because it has the best long term results for percentage excess weight loss and maintenance of that weight loss of any bariatric surgery. Any other sage advise on the wording?

I haven't mentioned it before but I have a degenerative disc condition from repetitive stress. This is irreversible and I have had one back surgery when I was 35 years old. I have 3 bulging discs and have to be very careful of my movements. It has been a factor in my weight gain over the last 20 years and another reason I am so eager to get this excess weight off.

I'm not sure if this is something that is relevent and would like to hear your thoughts on the subject.

The fight continues!!!!

Michelle

 

[DianaCox]

There is a part of me that would love to tell you to tell Dutta that you are in communication with Diana S. and the people who helped her and dozens of other people over the last 10-12 years get the DMHC to order Kaiser to send them to Dr. Rabkin, so cut the ********, but that would probably not be wise ...

If you've already gone to Dr. Rabkin's orientation, you could tell him that.

 

[Larra]

If your back condition requires you to take NSAIDs, or is likely to in the future, you could say that for this reason you can't even consider gastric bypass. That still leaves you with sleeve as an option, but you could (correctly) say that long term results with sleeve gastrectomy as a stand alone are not as good as with the DS, and that from your research you are seeing that a lot of people experience significant regain with the sleeve. Of course, he will respond that if you stick with the required post-op diet that won't happen, but the reality is that it does happen.

You could also say that you are aware of the vitamin and protein requirements needed with the DS, that you understand this is a commitment for the rest of your life, and you are prepared to comply with this requirement.

Frankly I don't think anything you say will help, and that it's more important not to say anything that can be put into your medical record and used against you when you do your appeals.

 

[michelle vasey]

I don't know what NSAIDs are. I'm sorry I don't have the medical knowledge you guys have. Even with my reading, I am not a veteran yet. My dad is dying from diabetes and has less than 12% kidney function. It worries me greatly.

Fast forward: I just got off the phone with Dr. Dutta who, quelle surprise, felt DS is too aggressive because of my BMI and weight. He stated it was just too big of a tool for my problem. He also threatened to remove the possibility of having the sleeve or bi-pass surgery covered by Kaiser stating if I had seen him first, he would not have offered me the surgery. I think that was mean to brow beat me into settling for the sleeve. He told me the next step, if I persisted in wanting the DS surgery, is to file a grievance with Kaiser. He let me know only 1 in 100 get overturned from his decision and was extremely dismissive of my argument for life long weight control. He also stated the "trend" across with country is away from the DS and stated Dr. Rabkin oversold the procedure because it was his bread and butter. I hadn't even mentioned him.

Can I please get some feedback on the Grievance Process and the comorbidity issues? I have high cholesterol am predisposed to diabetes and have my disc condition. Do any of those help with an argument for DS over the sleeve? It seems like it should be my choice. Obviously not.

I will be attending the meeting on August 8th and have requested a consult with Dr. Rabkin.

Thanks again to all of you for hearing me out. Your support means a lot especially with the push back I am getting from Kaiser!!

 

[Diana S.]

Fast forward: I just got off the phone with Dr. Dutta who, quelle surprise, felt DS is too aggressive because of my BMI and weight. He stated it was just too big of a tool for my problem. He also threatened to remove the possibility of having the sleeve or bi-pass surgery covered by Kaiser stating if I had seen him first, he would not have offered me the surgery. I think that was mean to brow beat me into settling for the sleeve. He told me the next step, if I persisted in wanting the DS surgery, is to file a grievance with Kaiser. He let me know only 1 in 100 get overturned from his decision and was extremely dismissive of my argument for life long weight control. He also stated the "trend" across with country is away from the DS and stated Dr. Rabkin oversold the procedure because it was his bread and butter. I hadn't even mentioned him.

Hahaha! I'm STILL blown away at how brazen they are with lies and deception and saying whatever it takes to dissuade you from appropriate care and how you've identified you would like to treat your issue. I have several swear words I've typed out and then erased... omg. I was going to post that I hated Dr. Dutta and I hope against hope that you had a better experience... but yeah... he's consistent at least. You should totally talk to him again, and say "remember Diana Sampson? You told her to go pound sand too... and guess what happened!" They threatened to revoke any offer of help from me too unless I listened to them unquestioningly.

On another note, another Kaiser surgeon told me that Rabkin was only in it for himself and that he was not to be trusted and a bunch of other bs. Rabkin is caring and careful and if he doesn't think it will be successful because of you or him or the specifics of the situation, he will tell you. He is honest and genuinely cares. I would make him part of my family if I could!

Can I please get some feedback on the Grievance Process and the comorbidity issues? I have high cholesterol am predisposed to diabetes and have my disc condition. Do any of those help with an argument for DS over the sleeve? It seems like it should be my choice. Obviously not.

Go back to my timeline for details, but you submit your grievance to Kaiser, you will get denied in writing, you take that denial and file a complaint with the Department of Managed Health Care (DMHC) and they will refer it to the Independent Medical Review (IMR). It will take 30 days from when they accept it for IMR to get a determination, and if you make sure all your ducks are in a row (unlike my experience, make SURE you have a psych eval, a nutrition/dietary eval, and Dr. Rabkin's Letter of Medical Necessity/LOMN all as a part of the submission to the DMHC) then you should get approval. The precedent is set. You qualify. The surgery is not "too aggressive" and if you're dedicated to the follow-up appointments, supplements and blood work then it is not any more of a risk than another WLS.

And if you're missing something and get denied, well there's still hope. I was approved AFTER THE THIRD TIME, thereby setting IMR history. Apparently, they use my case(s) as part of their training program now... yay?

 

[Diana S.]

I don't know what NSAIDs are.

Google says: Nonsteroidal anti-inflammatory drugs, or NSAIDs (pronounced en-saids), are the most prescribed medications for treating conditions such as arthritis. Most people are familiar with over-the-counter, nonprescription NSAIDs, such as aspirin and ibuprofen.

So it matters if you HAVE to take them to manage pain or whatever else on an ongoing basis, then the gastric bypass will not work because you may absolutely not take them any more with that surgery. You may continue to take them with the DS.

 

[michelle vasey]

Got it. Thanks Diana. I will move forward and have all you recommend to back me up. Yes, I HAVE to take Advil on a regular basis to cope with my back pain. I have a relatively high tolerance for pain after 20 years but have days where I have to take 3 pills 4 times per day. Opiates make me ill so I can not use them to cope with pain.

Maybe we can chat tonight if you have time?

 

[Diana S.]

I’d love to! My mother in laws birthday is today so we’re going out to dinner but I can message you when we’re home

 

[Larra]

michelle vasey at this point I would recommend you start a private conversation with me and DianaCox so we can all communicate via email. We can help you with your grievance and eventually with your IMR to the DMHC.
I'm not surprised that you got another denial, any other result would have been a big surprise, but it's sad and disturbing that anyone in a position of power would threaten to stop you from having bariatric surgery, or any other medically necessary care, based on your request for a specific standard of care procedure. That's just wrong.

 

[DianaCox]

That is outrageous that he is such a liar and a bully. I would file a complaint over that alone! I would guestimate (I don't keep track) that Larra and I have helped at least 30 NorCal Kaiser people get approved through the DMHC appeals process, and many more with BMIs over 50 who were sent directly to Rabkin when they asked, after Kaiser lost so many cases at the DMHC that they just gave up for the biggest, sickest people (probably hoping that it would improve their own damned statistics). However, Dutta et al. continue to resist letting anyone with a BMI under 50 go without a fight - THAT THEY ALMOST ALWAYS LOSE, at least when the patient is working with Larra and me.

I'm thinking of sending this link to my guy inside the DMHC ... any objections?

 

[Diana S.]

No objections from me! michelle vasey i concur with Larra that you should get to talking with her and Diana C. asap. I’m happy regaling my experience with you but Larra and Diana are the experts and they’re quite familiar with the lessons learned from my experience as well as countless others. But you always have my support and ear too!

 

[galaxygrrl]

michelle vasey

Michelle, I might or not be at Dr. Rabkin's group next week. But, do you want me to let you him know you are going? I'm also happy to talk to you about my experience with you. I actually went to MX, bu Dr. Rabkin has been very kind to me and I go to his group.