Does this mean what I think it means?

This is from my insurance plan document.

Obesity (Surgical Treatment): Covered only when weight exceeds 100% over ideal weight.

So does that mean that if my ideal weight is say 130#, my plan would not cover the surgery until I weigh 260# no matter what other health issues I have?

That is how I read it. If you have serious comorbidities, though, and at least BMI of 35, I would think you might be able to get them to approve on an appeal for medical necessity.

wouldn't it be 230?

No. 100%, not 100 pounds.