I'm still confused! Is it the surgeon or the insurance company?

Who decides what procedures are required before approval for surgery? I've read so many messages about psych exams, upper gi series, pre-op diets etc. etc. When I spoke to my insur. carrier I was told that my policy allowed for bariatric surgery when deemed medically necessary, including the lap band. However,it seems like there must be more to it than just getting my PCP or Surgeon to say that I need it. My BMI is 37 and my only co-mordid conditions are, degenerative disc, depression, heavy/irregular mentrual bleeding and general joint aches and pains that come with carrying around extra weight. Anyone have any insight? Thanks!

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