Posted by seattlebill on March 29, 2005 at 19:17:52:

In Reply to: kaiser and mma? posted by sleeepyinla on March 29, 2005 at 10:21:01:

Sleepy,

First, the surgeon should be practiced and proficient in airway surgery for sleep apnea. You may, for example, need to have tongue advancement to optimize your OSA treatment. Most ENT, orthognathic surgeons, trauma specialists can repair and wire a jaw...but they may not advance your tongue, etc...

As Mike said, the surgeon and his experience is key. Mike's guy, while "not an apnea
specialist", he pretty much is ; and has an international reputation for performing thousands of these or similar operations.

Now, will Kaiser-Permanente send you to other in-network locations that may perform more of these operations ? Sacramento, Bay Area, Portland, etc...? Also, if no in-network provider is available, try to have your sleep doc appeal to have your operation done by an out-of-network provider who can supply the best results. Stanford, Cedar-Sinai, (I wouldn't endorse 'SC for this...I don't know about UCLA),etc... The MMA is a complex and slightly unusual procedure that relies on experience and surgical judgement. I'm not sure if I'd like the fellow or resident doing more than assisting the attending in my case. But that's just my bias.

Argue (or go through the appeals process) with Kaiser that getting this operation done will spare you tens of thousands of dollars in treating other related conditions in the future. Getting this done by the right surgeon and getting it done well the first time will save you and Kaiser from many expensive problems related to the surgery in your post-op course. If there are no good in-network options, then I think you have a good case to get funded for an out-of network surgeon (fees negotiated I presume).

I'm a case-volume guy. That is why I went all the way to Stanford for surgery instead of staying in Seattle. The more MMAs that the surgeon and staff do, the better they can manage your operation and peri-op circumstances. If your otherwise well-trained maxillo-facial surgeons are re-learning this procedure when they are actually doing it (2-3 times a year)...

I'm sure some location in the Kaiser-Permanente performs a fair number of these. It is a huge network. If not try getting a case manager to work with an out of network appeal. I'm certain something will work out for you.

Good luck,

Bill

Follow Ups:

---

Copyright ©1995-2005 Sleepnet.com., All rights reserved