It is not worth trying. Your clause states it will not cover anything that has to do with weight loss except what they will allow (discount to a gym). So any time you go to a doctor, you can not discuss it on the off chance they use a weight loss code to file and then you are left paying the doctor bill in full. I met with a weight loss doc who was all ready for me to get the surgery until his office called BCBSTX and was told they cover nothing to do with weight loss for my contract. I cried, I worked hard to get to a better job to get better insurance and benefits so that I could attempt weight loss surgery to be told nope there is a clause. I took my 9 year old for a flu shot and because the doc discussed his weight, the doc office coded the visit as weight loss and not a flu shot. I got a lovely bill for almost $200 because my 5 ft 9 year old that wears a men size 8 shoe is actually over weight. I went through a month of fighting just to get that visit refiled correctly.

I had a similar problem with UHC when I looked into getting requirements from them back in July.  No one could answer how many months of nutritional classes I needed, or any other requirements nor could they refer me to any approved providers and I called several times and each time with a different person.  How is it that their representatives don't have the information you request?  Their representatives should have a cheat sheet on this stuff by now.  Any way, I went ahead with a program close to me because it seemed like most insurance companies require 6 months ($20/mo) plus copays for the specialist consults.  I completed everything, including all the consults and got the call today from a nurse at Optum Health Care who said I completed everything they require except for going through an "Optum" Bariatric Center of Excellence so they would have to DENY my claim but I could appeal.  

I knew the one in my local area said they were a Center of Excellence but I did not realize this is NOT a standard classification.  Each insurance company has their own set of standards apparently.  How was I to know that when UHC couldn't even tell me their requirements or even refer me to the 3rd party I was to apparently supposed to use?  UHC's plan through my husband's employer uses a third party, "Optum Health Care Bariatric Resources to verify and approve all their bariatric surgeries. I was in shock for them to deny me only because I didn't select a center of Excellence approved by them nor could they tell me if I could just go to an approved one without going through the whole process again.  They said that decision would be up to the surgeon.  REALLY!!??!!   Let me tell you, I cried and cried, screamed, cussed and screamed some more!!!  I have to fight my tears typing this now.  I have spent a lot of time, money, and effort to lose weight to only be told I didn't follow the proper steps but how can I prove that I was not given the proper information from UHC?  I only hope someone has the common sense to allow me to go through their Center of Excellence program without starting over the whole program and consults. I can't wait until Monday morning.  You know I will be on the phone on Monday morning with all involved.

 I will post what I find out for any of those who might be in the same position.  Please keep your fingers crossed.   I basically had to go through trial and error but I guess they want us to not be successful so they incur more costs!  That's all for now.  Sorry to vent so much. 

I hope you finally received the information you were looking for and are on the right path.  

thank you im going to see if this will work i was speaking to the surgeons nurse and she seems confident that everylittle biit will help so  next question i guess....how do i go about obtaining the medical records, just call and request or go to office and fill out paper work and submit paperwork fee?

I was recently diagnosed with psuedotumor cerebrei after the birth of my 2nd daughter in september. i am 5'6' 250 lbs and have been stuggling with my weight for about 5 years. I however have not been going to a pcp about my weight problem. How would I provide documentation of my obesity? I did visit weight loss clinics, and contacted one for my records, would i ask my gynocologist for records of my weight also? That would really be the only doctor i appeared to have seen in the past few years.