My weight at my annual PCP appointment last week put me at 40 BMI, but it normally hovers closer to 38-39.5. I am making the appointment to see the surgeon but didn't know if that weight would be the determining weight or one at the PCP?

Take is from me, Ms. 39.18 at her first surgeon appt! You best keep that, or even up it a tad. I am BCBS and my policy requires the 40 for full coverage automatic approval. I am scheduled to see my pcp this week to start the 6 month diet that BCBS requires because I was under 40. Now I have got to endure 6 months of frustration and uncertainty because of 3 lbs! People have been denied for diet non-compliance and denied because they succeeded on the diet. I have got to determine what the happy medium is gonna be and pray! I even had a provider tell me to gain at some point during my 6 months! It is so ridiculous that they make us jump through these hoops when we are wanting to get healthy and save them money in the long run. Oh! I am pre-diabetic on med, diagnosed fatty liver and asthma! However that is obviously not unhealthy enough. I have been a very dishearted and disappointed gal this week! Congrats, you are in a good position right now, the way I see it.

I actually work for BCBSTX & know the "fast-track" approval number is 40, but I do meet the co-morbidities criteria: hypertension (on 3 meds), CPAP, GERD, asthma among others. I guess it will come on the letter of medical necessity from the surgeon. Will post once I find out, thanks.

I'm going thru Kaiser and all though I don't qualify because the weight I do qualify because my co-morbidity. I am 4"11 and I weigh 184. I know thru Kaiser you have to be at least 100 lbs. over weight. Or have a high bmi (mine is 36) and a co-morbidity. I am diabetic, have high blood pressure and just diagnosed with OSA.

Wishing you luck and hope they don't give you the run around.

This is confusing to me as well. My BMI is 46 from my first weight with PCP and surgeon. If I lose weight and drop to a 40, is that ok? I always hear they go by your first weigh in with surgeon.

This is confusing to me as well. My BMI is 46 from my first weight with PCP and surgeon. If I lose weight and drop to a 40' date=' is that ok? I always hear they go by your first weigh in with surgeon.[/quote']

I think most plans have an automatic approval @40 but if you have the co-morbidities--between 35-39.9 qualifies, or at least that is true of my coverage.