Firefox, thanks that is so helpful to know. I finally found a more detailed explanation -- and here is what it says, in case this helps anyone else:
"Gastric restrictive procedures, gastric malabsorptive procedures and combination restrictive and malabsorptive procedures to treat morbid obesity -- a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with co-morbidities who has failed conservative treatment; eligible members must be 18 or over.
.....blah blah...prior approval....
...subject to the following pre-surgical requirements:
Diagnosis of morbid obesity for a period of 2 years prior to surgery
Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs...)
Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise.
Evidence that attempts at weight loss in teh 1 year period prior to surgery have been ineffective
Psychological assessment of the member's ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse
Patient has not smoked in the six months prior to surgery
Patient has not been treated for substance abuse for 1 year prior to surgery
My share: $150 per surgeon
$0 for anesthesia (if using a preferred provider)
$150 per day for hospital stay
$0 for diagnostic labs, ekgs as requested by physician
$25 per visit for psych (preferred provider)
So sounds pretty decent for coverage, I would say, I think I'm lucky if this all works out.
hope this info helps others, the thing i'm most curious about is the 3 month medically supervised deal...the paper work from the doc says they will not schedule surgery until all requirements are met and approval from insurance and they are scheduling a ways out, so its possible I may not make a 2011 date

boo. if I have to complete 3 months before they submit for authorization, that puts me at mid december, and if they are scheduling 2-3 months out for surgery....thats into march, which is NOT the timing I had hoped for at all. I wonder if there is any flexibility if its only the doctors requirements....hmmmmm...