The first response isn't quite correct.  It appears that at least 22 states will have obesity treatments, including bariatric surgery, included in their essential health benefits -- and unfortunately coverage seems to be largely determined by geography.  Sadly, many of the 27 states that have excluded surgery are in the south -- where some of the largest obesity problems exist.  

BTW, although obesity surgery isn't covered in every state in the exchange, Obama care has made it so that ALL policies must cover screening and counseling for obesity and at least one drug for it's treatment with no patient cost-sharing.  So while obamacare isn't perfect, it is better than what a lot of people had before it. Nothing.  

how did the peer to peer go?

I have UHC Commuity Plan thru Tennessee and my DS was approved almost immediately. Of course I went thru the same steps you did, but once my surgeon sent it in for approval I had a surgery date scheduled within a couple of weeks. No appeal necessary at all. 

Good luck! 

the first step is to go. To a surgeons informational seminar and they will start the ball rolling. From there. You can also make an appointment with your Pcp to discuss it with h/her and ask them to send a referral to your surgeon. You will still have to take the surgeons seminar. 

After the seminar,the surgeons office will follow up on your insurance requirements with the insurance co and tell you what you will need to do.

GL

I don't know who or where Miss Missy is.  All I know is during the time I had surgery (2009), her post was very instrumental in helping me ensure approval with Aetna. EP stands for Exercise Physiologists. Yes, the four consecutive months are crucial.  You can view the first month as being the start of it all and the three consecutive months as your checkin.  I started in August and had my last appointment in November.  I ensured I went to a nutritionist and ep that were familiar with the bariatric surgery process.  I don't know where you're located but you should be able to find someone.  For the 2 years of weights I called all my doctors that I had seen during that time that I know had a weight for me.  I pulled from my OB/GYN, Primary Care Specialist, I even went to the corner diet doctor that I had gone to see to get a copy of my records.  I supplied all of those record copies to my physician and had her to write me up something.  Now mind you, I had to do some modification to the original letter , but needless to say, I got it done and was approved within 4 days on the initial submittal.  Had surgery 12/23/2009.  By me having it at the end of the year, I was able to take advantage of all the OOP limits for the year.  All in all I was OOP about $2500.  Email me if you can... ericabaity at gmail dot com.

Take care,

Erica