Guest guest Posted May 20, 2001 Report Share Posted May 20, 2001 Hi all, I belong to a HMO, Kaiser in Oregon, and am in the loop to receive a open RNY as it is the only surgery they offer. The more research I do, the more it looks like the bd\ds is better for the long term. Anyone have any experience talking an hmo into letting you go out of network? warmly, Penny co morbids galore bmi 57 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2001 Report Share Posted May 20, 2001 Penny, I currently have Kaiser HMO and I have everything on hold until September when I plan to switch insurance companies to Great West PPO. Kaiser HMO (at least in Colorado) does not and will not do the BPD/DS (open or lap) or refer anyone to an outside specialist that does so. They have general Kaiser surgeons that do the RNY and they have also not learned the BPD/DS which is a more complex procedure. They still consider the BPD/DS 'investigational or experimental' regardless of the 10 year studies that have proven that is a safe procedure, plus more effective than the RNY. From what I've heard, Kaiser may have started approving it case by case in (can't remember if it's North or South)California, but then they also outsource the RNY (to Pacific Bariatrics, I think), so if the outsourced company does the BPD/DS, they maybe more willing to start approving people for BPD/DS, as it doesn't require additional training of their own surgeons. As for Kaiser in other states, I think the majority of them use general surgeons and don't outsource, so it would depend more on whether their general surgeons want to take the time to learn a new procedure or not. I have no doubts that Kaiser will eventually start performing the BPD/DS, just as they're starting to consider doing a laproscopic RNY procedure this year, but I doubt it would within the next year or so. Kaiser is a very slow moving cog for the most, so while they will get there, I have my health to consider and I'm not going to wait around for them. Good luck with whatever you decide! *hugs* Anita Pre-pre-op in Denver > Hi all, > I belong to a HMO, Kaiser in Oregon, and am in the loop to receive > a open RNY as it is the only surgery they offer. The more research > I do, the more it looks like the bd\ds is better for the long term. > Anyone have any experience talking an hmo into letting you go out of > network? > warmly, > Penny > co morbids galore > bmi 57 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2001 Report Share Posted May 20, 2001 I have a HMO, and recently did the same thing. I called my HMO to talk to them because on top of out of network, I will have to go out of state. They said that no matter who or where they are, if your PCP refers you to a doctor, then they approve it. So the key is talking you doctor into it. I am calling mine tomorrow to discuss it with her, and if she isnt willing to consider it, then I am off on a search for a new PCP. Sooo, again, if any of you chicagoites would be willing to tell me who your general practicioner is I would be eternally greatful. I could then change PCP's and get a consult date. I am very anxious. --- edensmom2@... wrote: > Hi all, > I belong to a HMO, Kaiser in Oregon, and am in the > loop to receive > a open RNY as it is the only surgery they offer. > The more research > I do, the more it looks like the bd\ds is better for > the long term. > Anyone have any experience talking an hmo into > letting you go out of > network? > warmly, > Penny > co morbids galore > bmi 57 > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2001 Report Share Posted May 20, 2001 I have a HMO, and recently did the same thing. I called my HMO to talk to them because on top of out of network, I will have to go out of state. They said that no matter who or where they are, if your PCP refers you to a doctor, then they approve it. So the key is talking you doctor into it. I am calling mine tomorrow to discuss it with her, and if she isnt willing to consider it, then I am off on a search for a new PCP. Sooo, again, if any of you chicagoites would be willing to tell me who your general practicioner is I would be eternally greatful. I could then change PCP's and get a consult date. I am very anxious. --- edensmom2@... wrote: > Hi all, > I belong to a HMO, Kaiser in Oregon, and am in the > loop to receive > a open RNY as it is the only surgery they offer. > The more research > I do, the more it looks like the bd\ds is better for > the long term. > Anyone have any experience talking an hmo into > letting you go out of > network? > warmly, > Penny > co morbids galore > bmi 57 > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2001 Report Share Posted May 20, 2001 Penny, I am experiencing the same Kaiser situation in San Francisco. The local answer is that you are more than welcome to go out of network, at your own expense. If you collect any info on any Kaisers covering an " out of system " DS please, please, please share the details. I would love to use them as a club upside the head locally. Quote Link to comment Share on other sites More sharing options...
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