Guest guest Posted March 8, 2006 Report Share Posted March 8, 2006 My daughter had her surgery approx. 3 years ago - Kaiser in So. SF. She reached her goal weight and was put on a waiting list for about year to be schudule to have the extra skin removed from her stomach. My daughter qualified to have Kaiser cover the cost of having this surgery done as she is having some major problems from the extra skin. She has a serve rush and the stomach hangs down so low that it is very difficult for her to do normal functional needs, like shower and even going the bathroom. Well after a year of waiting she finally got her surgery date for June of this year. I do not have to tell you how excited and happy she was, but just yesterday she was informed that because she moved to Placer Co. she is no longer covered by Kasier as they do not have membership available in that County. The disappointment is beyond words - my question is that I understood that when you had gastic surgery by Kaiser that you were always taking care of by them - even if you changed Insurance. Is this true and is there any thing my daughter can do to get Kaisier to cover her medically needed surgery? Thx for any suggestion Lucia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2006 Report Share Posted March 8, 2006 Lucia what part of Placer did your daughter move too. Has her premiums been paid regularly. Does she have other insurance. If she has other insurance then she must use the other insurance. She deserves the surg. If she has been paying her premiums or if an employer has then they must give her the coverage. If this is the case contact member services and put in a complaint. They are very good with helping out with almost any situation. I hope this helps RoseLucia wrote: My daughter had her surgery approx. 3 years ago - Kaiser in So. SF.She reached her goal weight and was put on a waiting list for about year to be schudule to have the extra skin removed from her stomach. My daughter qualified to have Kaiser cover the cost of having this surgery done as she is having some major problems from the extra skin. She has a serve rush and the stomach hangs down so low that it is very difficult for her to do normal functional needs, like shower and even going the bathroom.Well after a year of waiting she finally got her surgery date for June of this year. I do not have to tell you how excited and happy she was, but just yesterday she was informed that because she moved to Placer Co. she is no longer covered by Kasier as they do not have membership available in that County. The disappointment is beyond words - my question is that I understood that when you had gastic surgery by Kaiser that you were always taking care of by them - even if you changed Insurance. Is this true and is there any thing my daughter can do to get Kaisier to cover her medically needed surgery?Thx for any suggestion Lucia Yahoo! Mail Bring photos to life! New PhotoMail makes sharing a breeze. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 Lucia This is not true, you are only covered if you are in the areas covered, or with Kaiser. I am 11 months post op, and because of mine and Craig's split just lost my health coverage as of March 1st. I applied for individual plan which is the cheapest but was just denied because I had WLS and am a high risk patient, don't you love that. If you have had any problems, even seen a PCP 3 times in the last 12 months, or had any health issues like kidney stones, asthma, bad knees and so many more in the past 5 years you will be denied. So now I am reapplying for The Converson Plan and you pay way to much money one person $510 a month, but I need the medical so it sucks. I looked in to many plans and we are considered high risk everywhere now. So I will bit the bullet and do the Converson Plan and hope I get it. I know a lot of people with really bad health that got it. They just knock you out of the first category so fast, and with the second you don't need to supply medical information and that's how they make all kinds of money. It sucks but what are you to do. So NO they do not take care of you unless you are in the rules of Kaiser, even being only this far out. Take care. Tell you daughter I'm so sorry, I do understand. DonnaLucia wrote: My daughter had her surgery approx. 3 years ago - Kaiser in So. SF.She reached her goal weight and was put on a waiting list for about year to be schudule to have the extra skin removed from her stomach. My daughter qualified to have Kaiser cover the cost of having this surgery done as she is having some major problems from the extra skin. She has a serve rush and the stomach hangs down so low that it is very difficult for her to do normal functional needs, like shower and even going the bathroom.Well after a year of waiting she finally got her surgery date for June of this year. I do not have to tell you how excited and happy she was, but just yesterday she was informed that because she moved to Placer Co. she is no longer covered by Kasier as they do not have membership available in that County. The disappointment is beyond words - my question is that I understood that when you had gastic surgery by Kaiser that you were always taking care of by them - even if you changed Insurance. Is this true and is there any thing my daughter can do to get Kaisier to cover her medically needed surgery?Thx for any suggestion LuciaDonna JordonDSJordon@... Yahoo! Mail Bring photos to life! New PhotoMail makes sharing a breeze. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 Donna: Thanks for the information I will pass this on to my daughter. I am sorry to hear what you are going thru to get medical coverage, excuss me for saying this, but you should have your ex continue to cover your medical, under the circumstances you should be entittle to it. You may also consider getting alimony to help cover your medical expenses. Good luck Lucia > My daughter had her surgery approx. 3 years ago - Kaiser in So. SF. > > She reached her goal weight and was put on a waiting list for about > year to be schudule to have the extra skin removed from her stomach. > My daughter qualified to have Kaiser cover the cost of having this > surgery done as she is having some major problems from the extra > skin. She has a serve rush and the stomach hangs down so low that it > is very difficult for her to do normal functional needs, like shower > and even going the bathroom. > > Well after a year of waiting she finally got her surgery date for > June of this year. I do not have to tell you how excited and happy > she was, but just yesterday she was informed that because she moved > to Placer Co. she is no longer covered by Kasier as they do not have > membership available in that County. The disappointment is beyond > words - my question is that I understood that when you had gastic > surgery by Kaiser that you were always taking care of by them - even > if you changed Insurance. Is this true and is there any thing my > daughter can do to get Kaisier to cover her medically needed surgery? > > Thx for any suggestion > > Lucia > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 Donna: Thanks for the information I will pass this on to my daughter. I am sorry to hear what you are going thru to get medical coverage, excuss me for saying this, but you should have your ex continue to cover your medical, under the circumstances you should be entittle to it. You may also consider getting alimony to help cover your medical expenses. Good luck Lucia > My daughter had her surgery approx. 3 years ago - Kaiser in So. SF. > > She reached her goal weight and was put on a waiting list for about > year to be schudule to have the extra skin removed from her stomach. > My daughter qualified to have Kaiser cover the cost of having this > surgery done as she is having some major problems from the extra > skin. She has a serve rush and the stomach hangs down so low that it > is very difficult for her to do normal functional needs, like shower > and even going the bathroom. > > Well after a year of waiting she finally got her surgery date for > June of this year. I do not have to tell you how excited and happy > she was, but just yesterday she was informed that because she moved > to Placer Co. she is no longer covered by Kasier as they do not have > membership available in that County. The disappointment is beyond > words - my question is that I understood that when you had gastic > surgery by Kaiser that you were always taking care of by them - even > if you changed Insurance. Is this true and is there any thing my > daughter can do to get Kaisier to cover her medically needed surgery? > > Thx for any suggestion > > Lucia > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 --- Rose: Thank you for the suggestions. I will check with my daugher to find out if the premiums were paid. I do believe she has been in touch with member services, but the next step is to put in a complaint. The real sucky part is, she moved to Roseville - just a few miles outside of the Sacramento Co area. Luci In gastric-bypass-support-kaiser-patients , Rose wrote: > > Lucia what part of Placer did your daughter move too. Has her premiums been paid regularly. Does she have other insurance. If she has other insurance then she must use the other insurance. She deserves the surg. If she has been paying her premiums or if an employer has then they must give her the coverage. If this is the case contact member services and put in a complaint. They are very good with helping out with almost any situation. I hope this helps > Rose > > Lucia wrote: > My daughter had her surgery approx. 3 years ago - Kaiser in So. SF. > > She reached her goal weight and was put on a waiting list for about > year to be schudule to have the extra skin removed from her stomach. > My daughter qualified to have Kaiser cover the cost of having this > surgery done as she is having some major problems from the extra > skin. She has a serve rush and the stomach hangs down so low that it > is very difficult for her to do normal functional needs, like shower > and even going the bathroom. > > Well after a year of waiting she finally got her surgery date for > June of this year. I do not have to tell you how excited and happy > she was, but just yesterday she was informed that because she moved > to Placer Co. she is no longer covered by Kasier as they do not have > membership available in that County. The disappointment is beyond > words - my question is that I understood that when you had gastic > surgery by Kaiser that you were always taking care of by them - even > if you changed Insurance. Is this true and is there any thing my > daughter can do to get Kaisier to cover her medically needed surgery? > > Thx for any suggestion > > Lucia > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 I think the issue here is whether she is still a Member of Kaiser. If her coverage was cancelled, because her premiums are not being paid anymore...than of course Kaiser won't be paying for the cost of the surgery. This is not a mandatory corrective surgery that they are doing because they messed up the first time around. This is just a natural consequence (sometimes) for some of the people that lose a bunch of weight. So, the notion that Kaiser is responsible or that "once Kaiser, always Kaiser" is just not the way it works. Now, if it is that she simply is living in a different county where there is no Kaiser coverage, but she's paid her premiums in good faith, and she lives close to a Kaiser facility (Roseville), that may be something that customer service can help you with. But, the bottom line is that if the surgery is medicalloy necessary, it is medically necessary. So, if she has other insurance coverage, they would probably deem it medically necessary, as well. Good luck, RobynnLucia wrote: ---Rose: Thank you for the suggestions. I will check with my daugher to find out if the premiums were paid. I do believe she has been in touch with member services, but the next step is to put in a complaint.The real sucky part is, she moved to Roseville - just a few miles outside of the Sacramento Co area.LuciIn gastric-bypass-support-kaiser-patients , Rose wrote:>> Lucia what part of Placer did your daughter move too. Has her premiums been paid regularly. Does she have other insurance. If she has other insurance then she must use the other insurance. She deserves the surg. If she has been paying her premiums or if an employer has then they must give her the coverage. If this is the case contact member services and put in a complaint. They are very good with helping out with almost any situation. I hope this helps> Rose> > Lucia wrote:> My daughter had her surgery approx. 3 years ago - Kaiser in So. SF.> > She reached her goal weight and was put on a waiting list for about > year to be schudule to have the extra skin removed from her stomach. > My daughter qualified to have Kaiser cover the cost of having this > surgery done as she is having some major problems from the extra > skin. She has a serve rush and the stomach hangs down so low that it > is very difficult for her to do normal functional needs, like shower > and even going the bathroom.> > Well after a year of waiting she finally got her surgery date for > June of this year. I do not have to tell you how excited and happy > she was, but just yesterday she was informed that because she moved > to Placer Co. she is no longer covered by Kasier as they do not have > membership available in that County. The disappointment is beyond > words - my question is that I understood that when you had gastic > surgery by Kaiser that you were always taking care of by them - even > if you changed Insurance. Is this true and is there any thing my > daughter can do to get Kaisier to cover her medically needed surgery?> > Thx for any suggestion > > Lucia> > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 > > My daughter had her surgery... but just yesterday she was informed that because she moved > > to Placer Co. she is no longer covered by Kasier as they do not > have > > membership available in that County. > > Something else must be going on here, because I live in Placer County (Lincoln), just north of Roseville and my PCP is located in Roseville...no coverage problems here...it IS rather crowded at the Roseville facilities, but if she is a member, she is covered here. Good luck. Shonda. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 Lucia He has agreed for the allimony, but the his union won't keep me on we live at 2 separate places. So the allimony does help, but it's still a lot of money for health coverage. He is being more than fair and has to have enough money to live on also, especially since he really can't cope with any work situation and what pension he has left will be just enough to make it month to month. I on the other hand can work more if needed. Thanks for your thoughts, things are easy, but with time and prayers all will get worked out for everyone. Take care. DonnaLucia wrote: Donna: Thanks for the information I will pass this on to my daughter. I am sorry to hear what you are going thru to get medical coverage, excuss me for saying this, but you should have your ex continue to cover your medical, under the circumstances you should be entittle to it. You may also consider getting alimony to help cover your medical expenses.Good luck Lucia> My daughter had her surgery approx. 3 years ago - Kaiser in So. SF.> > She reached her goal weight and was put on a waiting list for about > year to be schudule to have the extra skin removed from her stomach. > My daughter qualified to have Kaiser cover the cost of having this > surgery done as she is having some major problems from the extra > skin. She has a serve rush and the stomach hangs down so low that it > is very difficult for her to do normal functional needs, like shower > and even going the bathroom.> > Well after a year of waiting she finally got her surgery date for > June of this year. I do not have to tell you how excited and happy > she was, but just yesterday she was informed that because she moved > to Placer Co. she is no longer covered by Kasier as they do not have > membership available in that County. The disappointment is beyond > words - my question is that I understood that when you had gastic > surgery by Kaiser that you were always taking care of by them - even > if you changed Insurance. Is this true and is there any thing my > daughter can do to get Kaisier to cover her medically needed surgery?> > Thx for any suggestion > > Lucia> > > > > > > > Quote Link to comment Share on other sites More sharing options...
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