I posted this in another forum but it was the wrong one. Hopefully someone can help here.... I am 6'5" 291 32 y/o male. I am 4 lbs away from 35 BMI. I have been between 32-34.5 ish on BMI the last few years. Do I need to gain 4lbs to qualify at 35 (my insurance says 35BMI with a comorbidity and I have high BP and GERD)? Anyone have problems if you were a little less than 35 in the past 5 years?

Pretty much... did you talk to your doctor?

It depends on your insurance. Some require a 5 year history, some don't. Have you called them?

You might be able to appeal that requirement by stating that the National Institutes of Health do not recommend a 5 year history as part of the criteria for patient selection. You can read about it here:

http://consensus.nih.gov/1991/1991GISurgeryObesity084html.htm

In order to appeal, you'd have to have been denied first.

Oh, forgot to add, the FDA just approved the band for BMI as low as 30. That might help, too!

I haven't even started the process yet with a doctor. I wonder if it is even worth it since I am low BMI.

Yes, it is. Just because your BMI is lower, doesn't mean you aren't overweight or obese. Are you gaining each year? A BMI of 30 puts you as obese. Whether or not you choose to proceed with surgery is a decision for you and your doctors.

I am not saying you should have the surgery, but don't rule it out just because you fear that your insurance might not cover it. Find out the facts first. I had to appeal my medical group's decision to not allow me to see my surgeon. I won. It was a simple fight. Don't run. Get the information, then decide.

YAY! I finally confirmed with my insurance. They cover surgery with no diet requirement and no history of 5 years of BMI being high, etc. All they require is BMI > 35 and 1 comorbidity.