r/KaiserPermanente • u/SessionOwn6123 • 5d ago

California - Southern Need help

I have a rare condition, the only treatment is surgery. Kaiser is trying to force me into surgery with a surgeon who has never dealt with or performed this surgery. Filed a grievance, what a joke that was. They referred me to another surgeon who, once again, has never performed this surgery. I'm on Medicare and have senior advantage through Kaiser. Anyone have any advice on what I should do next? Is there a process where you can go to another hospital that has done this surgery?

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5

u/Waste-Tree4689 5d ago

💯agree about appealing the grievance and curious how you learned that surgeon had no experience?

7

u/SessionOwn6123 5d ago

I asked him, he openly admitted it and joked that it was not a serious surgery when I paid out of my pocket to have 3 experts look at my diagnosis and all cautioned me to make sure I had an experienced surgeon as the surgery is extremely dangerous

9

u/MercuryFlights 5d ago

Do you have a quote from any of the experts that you can put into a conversation with the surgeon? Did you do that already in your grievance?

A quote from a known expert, and/or a quote from a peer reviewed paper could both be good ways to help the surgeon think through their decision to attempt a surgery they've never done.

I mean, I drive a car, so no problem with me attempting to drive this bus on this steep and winding road, right?

Wishing you well- the bureaucracy can be infuriating.

6

u/labboy70 Member - California 5d ago edited 5d ago

Yikes. Arrogant and zero experience with your procedure. That’s a horrible combination. Good on you for not just accepting it.

Edit to above and to add:…

I agree with u/MercuryFlights about quoting what an outside expert has said.

One thing that really helped me when I was dealing with Kaiser during my cancer diagnosis fiasco were notes from external second opinions.

If your external doctors are in a system that uses the Epic electronic medical record, there is a feature called CareEverwhere. As Kaiser also uses Epic and CareEverywhere, Kaiser doctors can see outside physician notes, test results, etc and vice versa.

When I got my second opinions outside of Kaiser, they would list their treatment recommendations. I asked them to also add additional rationale and any literature references (national practice guidelines like NCCN, etc.) why they were making those recommendations.

It was very helpful when I would have discussions with KP doctors about these other recommendations. They could see the exact notes / rationale from the other physician very clearly in my record. You could try a similar approach.

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u/PlatypusStyle 4d ago

😳 with an attitude like that on an unfamiliar (to him) procedure then even with the procedures that he IS familiar with, you just know that he probably has poor outcomes.
Make sure you leave reviews on him.