Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 Kay, In one of the other posts, you talk about the NIH guidelines. I have had a little problem with Kaiser. I was advised by someone who works for the doctor who is doing my surgery. She suggested that I write the Van Buren Medical Office doctor, Dr. Provonsha. I wrote him a letter telling him that I had contacted the DMHC and that they suggested that I try to work things out with him before filing a full complaint. I told him about the NIH guidelines of 40 or higher with no co-morbidities. I am currently at a BMI of almost 49 and am 135lbs overweight. He called me back and told me that if everybody went by the NIH guidelines, then 6.9% of the population would be considered overweight. He then proceeded to tell me that would mean that it would take 20 years for each person to get surgery. I told him that not everyone with a BMI of 40+ wants the surgery. I just felt discriminated against since they took 6 months looking for co- morbidities with my current BMI. They then require you to take the classes, 8 if you have diet documentation and 24 if you don't. These are the once a week classes. The problem with the Van Buren office is, they have no classes available at this time and do not know when they will be starting any new ones. I asked him how they could require us to take classes that aren't available. He said that they will be available at some time. I also told him that Fontana does not have enough people to fill classes, so why is Riverside so backed up??? He said he was going to contact Fontana and he could refer me there for the classes, if he found out it to be true. I just get so frustrated with the process, but I am not going to quit. I was hoping to have the surgery this summer as I work during the school year. He said that he understood, but that was it. What does the DMHC do? Do you think that I should actually contact them? I just don't know what to do? Any suggestions would be greatly appreciated. Patty Riverside Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted March 22, 2005 Hi Patty, First off, let me confess that I am not especially familiar with the way things work down in your neck of the woods - but I am appalled at that doctor's attitude. I've never had any experience with the DMHC myself. (My BMI was 70.9 so they approved me without even thinking twice.) My understanding is that you should try Patient Assistance within Kaiser first, but if that doesn't resolve the situation, then you file a complaint with the DMHC. They will review your case and make a determination - I believe within 30 days is the standard. The DMHC can, in fact, mandate that Kaiser provide you with the care you need - in this case the WLS. I think that others here may have had to appeal to the DMHC. I am hoping that they will chime in. If I were in your position, I'd contact Patient Assistance immediately and start writing up my complaint to the DMHC. If Patient Assistance wasn't making progress soon (possibly give them a couple of weeks), I'd file the complaint. I am sorry to hear that you are getting such a run-around. You deserve to be treated better. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted March 22, 2005 Hi Patty, First off, let me confess that I am not especially familiar with the way things work down in your neck of the woods - but I am appalled at that doctor's attitude. I've never had any experience with the DMHC myself. (My BMI was 70.9 so they approved me without even thinking twice.) My understanding is that you should try Patient Assistance within Kaiser first, but if that doesn't resolve the situation, then you file a complaint with the DMHC. They will review your case and make a determination - I believe within 30 days is the standard. The DMHC can, in fact, mandate that Kaiser provide you with the care you need - in this case the WLS. I think that others here may have had to appeal to the DMHC. I am hoping that they will chime in. If I were in your position, I'd contact Patient Assistance immediately and start writing up my complaint to the DMHC. If Patient Assistance wasn't making progress soon (possibly give them a couple of weeks), I'd file the complaint. I am sorry to hear that you are getting such a run-around. You deserve to be treated better. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted March 22, 2005 Patty -- My sister-in-law was denied for WLS through Kaiser. She first had to contact patient assistance and fill out some grievance paperwork and then they reviewed it again, and denied her again. She then filed a complaint with the DHMC. Because she met the NIH (National Institute of Health) guidelines, the DHMC overturned Kaiser's decision and required that Kaiser cover her WLS. All " overturns " go through the South San Francisco site (from what they told my sister-in-law). She is having her surgery a week from tomorrow (March 30th). There is hope! I'd get a grievance filed with Patient Assistance ASAP so that you can get the ball rolling. Good luck! Keep us posted! Tina Pre-Op / Richmond Dr. Baggs 330/303.5/6.5 more to go! > Hi Patty, > > First off, let me confess that I am not especially familiar with the way > things work down in your neck of the woods - but I am appalled at that > doctor's attitude. > > I've never had any experience with the DMHC myself. (My BMI was 70.9 so > they approved me without even thinking twice.) My understanding is that > you should try Patient Assistance within Kaiser first, but if that > doesn't resolve the situation, then you file a complaint with the DMHC. > They will review your case and make a determination - I believe within > 30 days is the standard. The DMHC can, in fact, mandate that Kaiser > provide you with the care you need - in this case the WLS. > > I think that others here may have had to appeal to the DMHC. I am > hoping that they will chime in. > > If I were in your position, I'd contact Patient Assistance immediately > and start writing up my complaint to the DMHC. If Patient Assistance > wasn't making progress soon (possibly give them a couple of weeks), I'd > file the complaint. > > I am sorry to hear that you are getting such a run-around. You deserve > to be treated better. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2005 Report Share Posted March 22, 2005 Patty -- My sister-in-law was denied for WLS through Kaiser. She first had to contact patient assistance and fill out some grievance paperwork and then they reviewed it again, and denied her again. She then filed a complaint with the DHMC. Because she met the NIH (National Institute of Health) guidelines, the DHMC overturned Kaiser's decision and required that Kaiser cover her WLS. All " overturns " go through the South San Francisco site (from what they told my sister-in-law). She is having her surgery a week from tomorrow (March 30th). There is hope! I'd get a grievance filed with Patient Assistance ASAP so that you can get the ball rolling. Good luck! Keep us posted! Tina Pre-Op / Richmond Dr. Baggs 330/303.5/6.5 more to go! > Hi Patty, > > First off, let me confess that I am not especially familiar with the way > things work down in your neck of the woods - but I am appalled at that > doctor's attitude. > > I've never had any experience with the DMHC myself. (My BMI was 70.9 so > they approved me without even thinking twice.) My understanding is that > you should try Patient Assistance within Kaiser first, but if that > doesn't resolve the situation, then you file a complaint with the DMHC. > They will review your case and make a determination - I believe within > 30 days is the standard. The DMHC can, in fact, mandate that Kaiser > provide you with the care you need - in this case the WLS. > > I think that others here may have had to appeal to the DMHC. I am > hoping that they will chime in. > > If I were in your position, I'd contact Patient Assistance immediately > and start writing up my complaint to the DMHC. If Patient Assistance > wasn't making progress soon (possibly give them a couple of weeks), I'd > file the complaint. > > I am sorry to hear that you are getting such a run-around. You deserve > to be treated better. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.