Question:
My friend has Kaiser, what is the protocal for getting RNY through them?
My friend is trying to get RNY done through Kaiser, but I want to help her out and jump ahead to find out if anybody knows the hoops Kaiser has you jump through to get surgery through them? Thanks in advance — Kristy (posted on October 11, 2007)
October 11, 2007
Hello Kristy,
My sister is currently in the program with Kaiser. She is waiting for the
Lapband procedure but will not be gauranteed to have it. They might want
her to have the RNY. With Kaiser, you must first see your Primary Care
Provider. Your Primary care provider will then refer you into the program
for the surgery. After being referred, all patients must go through a
six-month weight loss program in which they want you to lose 10 percent of
your body weight. They have meetings once a week for six months and
actually have homework to do! My sister hated it. Then, after the six
months, you are scheduled for surgery. But also, all the highest risk
patients are scheduled first. Kaiser does mostly Gastric Bypass or RNY.
They only do about 10-15 Lapbands per month. Any questions, just let me
know.
Lynda Cavallo
— Lynda C.
October 11, 2007
Hi Kristy- I have been a Kaiser member for 36 years and was an employee of
NCal Kaiser for 24 years- the requirements vary from region to region- your
PCM must refer you to the program- then they screen your medical history
and determine if you are elegible - next in most regions there is a 10-12
week mandatory weekly class (you can't miss any or you have to pay the
registration fee and start all over again, then a work up with dietitian,
psych, and the bariatric dept. Then the surgeon. I had my surgery a
K-Denver- they contract with outside bariatric surgeons- I had Dr. Brown-
he is fantastic- I had the lap RNY 18 mos ago and have lost a little over
155#. Then after surgery you have monthly f/u with the bariatric support
group- I live about 75 miles from Denver so now I only go about every
quarter up to Denver but I keep in touch with the staff via email. The big
thing with Kaiser (and it is a good thing- speaking as a patient and an RN)
is that they want to know you are committed to the follow-through.
Otherwise it is a big waste of their time and money if you just go back to
your old ways. Kaiser can be slow to respond to new innovations however
they want to know that they are doing something correctly before they step
into the arena. By the way the process from my history working in Ca and my
own personal experience takes about 1 year from date of application to
surgery. Good luck. Write if you need any Kaiser support, would be happy
to help if I can. Donna 286/131
— dabby
October 11, 2007
I have Kaiser and I am in the process myself. This is what I had to do, but
the process may vary depending on the state and your policy coverage. The
first thing I had to do was see my PCP, let them know you are interested in
WLS and they will refer you to an endocrinologist. The endocrinologist will
take a look at your history/health, blood tests, etc. and require you to
see a nutritionist and a behavior health specialist. I had to visit the
nutritionist once a month for 6 months and I made 12 visits to the behavior
health specialist over a course of 5 months, which also included several
group meetings. In addition, I was required to attend at least 3 support
group meetings outside of Kaiser.
After finally finishing up all my required visits (after about 6 months),
the nutritionist and the behavior health specialist send their
recommendations to the endocrinologist and the endocrinologist looks at all
the recommendations and provides a report/recommendation to the review
board to determine if you should be send to the surgeon. For me, this took
about 3 weeks before I got my referral to the surgeon.
Then once I saw the surgeon yesterday, I was set up to take a Pulmonary
Test, a Cardiology Test, Upper GI, and ultrasound. Once I get all my
appointments for those tests, I will call the surgeon and let him know the
dates and then he will call me back with a surgery date.
Yes it is a LOOOOONG process and it requires lots of patience, but as I
look back I realize it was worth it because I learned so much. Best wishes
to your friend!
— MsKeke
October 12, 2007
Hi! I had Kaiser and started the process in 7/04. After many hoops to
jump through such as classes, an MMPI and many appointments I was approved
in 6/05. They require a loss of 10% of total body weight. I was not
impressed with the surgeons in fremont Ca at all. My employeer changed
from Kaiser to Pacificare in 7/05 so I ended up not having surgery through
kaiser.
— Blonde_Sanchez
October 24, 2007
Hi, I have Kaiser in Southern Cali and am going through their program to
have the RNY done. You have to get a referral from your PCP first, then
attend both the Weight Mgmt & Options orientation. Complete the 6
month Options class and lose 10% of your body weight. The classes are once
a week for 24 weeks. Any classes that are missed will need to be made up.
They will send you for blood work around week 5 or 6 and then again at week
20. Once all of the "hoops" have been jumped you will be given
your auth# and referred out to the surgeon. Right now in So Cal you have
the choice between UCLA Med Cntr or Pacific Bariatric in San Diego. At
this time we were informed that the Lap Band procedure is NOT a covered
benefit! Hope that this helps your friend out. If you should have any
other questions do not hesitate to ask me. I am currently on week 16 of 24
and cant wait for the end!
— slayer_meow
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