Consult with surgeon denied

I am ready for battle. After the many phone calls with my medical group and doctor's office I have learned that generally my medical group will deny all first requests for a concult with a weight-loss surgeon.  Pacific Care of CA denied my doctor's request because I did not meet thier criteria of 6 months in their new Healthy Roads program.   Is this legal? Can they require that?  Its not even a supervised diet, its a weekly coaching phone call. 

Good Luck with pacificare... I did not even know they covered WLS that is why I switched to Aetna....and guess what?  I just got my denial letter....bummer....I am going to appeal. Good luck to us Sonja