RCI Approval? Continous supervised diet?

Okay, i have been fighting the battle for a while now. I recently switched jobs and am working for a new company that has RCI (self-funded) insurance. I have checked the exclusions and weight loss surgery is NOT excluded for the treatment of morbid obesity.   Has anyone had any trouble getting approval from RCI? I have met all of their requirements w/ the "physcian working in cooperation w/ nutritionist/dietian" being sketchy. RCI's requirements are:

Clinically Severe Obesity (Morbid Obesity) is a diagnosed condition in which the body weight exceeds the medically recommended weight by either 100 pounds or is twice the medically recommended weight for a person of the same height, age and mobility as the Covered Person.

Your letter indicates this patient has a BMI of 47.7 and 178 pounds overweight which meets this Plan’s definition of morbid Obesity.

 For the surgery to be medically necessary the following criteria must be met:

1. Presence of morbid obesity that has persisted for at least 5 years, defined as either :  BMI exceeding 40 OR

BMI greater than 35 in conjunction with ANY if the following severe co-morbidities: coronary heart disease, type 2 diabetes, clinically obstructive sleep apnea or hypertension; AND

2. Patient has completed growth (18 years of age or documentation of completion of bone growth); AND

3. Patient has attempted weight loss in the past without successful long-term weight reduction; AND

4. Patient has participated in a physician-supervised nutrition and exercise program documented in the medical record.  This physician- supervised nutrition and exercise program must meet ALL the following criteria:

• Must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists;
• Must be six months or longer in duration
• Must occur within the two years prior to surgery; AND
• Must be documented in the medical record by an attending physician who does not perform bariatric surgery.

Documentation from the patient’s primary doctor is required to meet the criteria listed in 4 above. 

A psychiatric evaluation may be needed for final approval based on the patients history, but will be determined at a later date based on other data received.