seriously?? are you sure those aren't your surgeon's requirements?
i have medicare and i was accepted by my surgeon immediately as i have a 35+ BMI and hypertension.
Medicare does NOT do prior-authorization so most surgeons try to be as stringent as possible before doing the surgery. Surgeons are supposed to charge the full amount to the patient beforehand, perform the surgery, and then receive 80% from Medicare (if they approve).
Depending on your surgeon's office, you may not have to pay upfront, as is the case for me.
Medicare itself only requires the 40+ BMI or 35+ w/ comorbidity, as long as the surgery is done at a center of excellence and with an approved surgeon.