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Since my PCP's practice is the direct subset of the hospital where I would have the bypass surgery, I really want to at least stay at that practice since it would be a direct link into the hospital's WLS program. It's odd that their Weight Clinic is so reputable, yet the docs at the family practice (at least the few I have encountered so far) don't seem friendly to it at all. But then again, I haven't yet directly asked about this procedure, either, so who knows...

Janh, thanks for the tips regarding Highmark. When I called to see if they covered the procedure, I was quite surprised that they said they did-- since I have gone to my PCP on one occasion specifically to discuss weight issues, and the insurance denied my claim for the office visit since they said they don't cover weight management.

Which brings me to another question-- I've since read my member handbook cover to cover, and while it lists weight management under the exclusions, it DOES say something like "except in cases of morbid obesity where a doctor deems it medically necessary." I'm wondering if, when the office submitted the claim, they said "obesity" instead of "morbid obesity" or something. I plan to list the reason for requesting a visit as "joint and back pain" when I schedule, but I know that if I decide to go through with this, I'm going to making MANY doctor's visits... can I expect that my insurance will deny all of them if they're deemed weight-related? (That seems like SUCH crap to me.)

What happens, though, if you participate in the 6-month supervised weight loss program and you do well? Does that make you ineligible for the surgery? Is it a question of a person needing to lose SOME weight, but also being careful not to lose TOO much weight or else they won't be considered for surgery? It feels like another trap for the insurance company.

I have a feeling that I'm going to have to become well-versed in my insurance company's appeals process before this is all over...