FYI - I was approved by BCBS (verbal to Dr's insurance clerk) back in Nov. of 2007.  We got all the info together, set a date and sent the letter for final approval.  A BCBS rep called back to ask the Dr. to wait until after the first of Jan. 2008 due to some "issue".  It's been too long and I don't remember the exact details.  Any way, The Dr.'s office called and asked me about waiting and since I didn't really have a problem with it, we agreed.  After the new year, the Surgeon's office wrote for the final surgery approval.  The Dr. was casually advised that as of Jan. 01, 2008, my BCBS plan no longer covered ANY weight loss process.  They wouldn't even pay for a Dr's office visit if the sole purpose was regarding weght loss.
     I was totally out of luck for 3 year.  I didn't even know they had added WLS back on until Nov. of last year when I got my new benefits booklet and ACCIDENTLY saw the surgery listed at the very back of the book. 
     I immediately got back with my surgeon and BCBS had turned me down 3 times.  Finally I got a tenative approve but first I had to do a 6 month (180 day) diet.  At the end of the 5th month of the first diet period, my bariatric surgeon was advised that BCBS had just changed their requirements and the 6 month diet had to be completed with my PCP, not the surgeon.  Here we go again I thought!  I had to start all over again with my PCP doing the 6 month diet.  I joined Weigh****cher's too, just to be on the safe side.  So instead of failing on a diet for 6 months, I ended up doing it for 11 months.  Nothing like BCBS making sure you end up feeling like a complete and utter failure for as long as they possibly can!
     I have finally been approved for RNY and have a surgery date set for 11/29/2010.  I won't believe it until I am in recovery and my guts have been cut out!  I don't trust BCBS any further than I can throw their building! 
     The lessons here?  Get your approval in writing from your insurance company and get the surgery completed as soon as you can comfortably afford to do so!

Would it be an appeal or a resubmital of the application with all the documentation.

I started my pre op diet before my last appointment because of this reason I realized I had gained 10 pounds somehow during the month before.... I dieted like crazy protein shakes and no carbs and lost all but one pound which my doctor didnt consider a gain. This time I have lost quite a bit because I just stayed on the diet very closely. I am almost concerned that maybe im losing more than I should but I am not gunna sabotage weight loss that will make me healthier during surgery.

The surgeon's suggestion is a suggestion, but ultimately it is your decision which surgery to have. If you want the gastric bypass, and you meet the criteria to qualify, I don't see why you can't get it. If your surgeon won't do it, I might talk to a different surgeon.

Good luck!

Tonia

I thought you were talking about me for a minute... I am in the same situation... pre-cert denied, appeal denied all because the physician supervised program wasn't to their liking... my doc and surgeoun think its absurd but what can you do... I restarted a physican supervised program in August and hope to start over mid January.