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This is so interesting!  I have already been appoved by Kaiser (at least as far as I know)  Now it is up to the surgeon if he will do the surgery.  I do not forsee any problems there, but I wish I knew this info before I attended SIX months of classes.  LOL

Jessika,
I have Kaiser - No Calif.  I'm in Sac.  Kaiser paid for my DS in April 08.  I did have to go through DMHC, as Kaiser only will do the RNY & LapBand and I needed the DS to cure my diabetes, which it did.  Once your PCP puts in a request for Kaiser's Bariatric Program, you will be accepted or not.  I wasn't, as the surgeon made a comment that I wasn't big enough for surgery.  Also, once your PCP has made the referral, you are suppose to hear back in 5 days.  I waited 6 weeks to hear and wouldn't have known, if I hadn't emailed my PCP back with a question about my referral.  Once you get your orientation at Kaiser, I was sent to the So SF office, my orientation was 2/4/08 and I was accepted into their program on 12/19/07.  Surgery for a RNY would have been 28+ weeks after 2/4/08, the surgeons were that backlogged.  I have several posts over on http://www.duodenalswitch.com/forum under Insurance Issues.  My denial letters both local and regional.  My DMHC ruling is MN08-7644. 

I have a copy of the formal letter I used to fight my insurance on the top of my blog. After excuses and constant delays, I switched doctors twice only to find out the group would do this forever. Switched to a different group and supportive doctor, gave a copy of the attached letter and the rest was history!  My HMO paid every last dime!!!!

What if we live in California but our insurance is out of California. My employeer has BCBS of Minnesota PPO. I just recently got denied because of the 6 month diet. My BMI is 55 and I have completed everything else. I was just wondering if I should try fighting it. I am not sure a PPO plan out of state would have to abide by these guidelines.

The above info is great and thank you for all the documentation! I just wanted to point out that please remember that HMO, PPO etc. only applies to fully insured plans --- so if your plan sponsor is fiducuary and your plan is self insured no state mandates apply!

I wish I lived in CA... LOL

It truly is great info you have supplied!