I too am appealing BCBS of Ca decision of not medically necessary. My BMI is 38.1, with and RMR of -53. The co morbitities I have are moderate hiatal hernia that causes severe reflux, arthritis in my hips, and chronic low back pain. My maternal family history is full of Diabetes. My mother, grandmother and grandfather all had insulin dependent diabetes. I am headed right down that road. I can fix all the lifestyle things but I cannot change my genetics. I just cannot understand the insurance company's rational. The funny part is that the letter says that it can be approved at a BMI of 40. I am so dang close to that that part of me says, "ok, I can gain that much weight without trying, I just have to look at food!" but that really seems irresponsible to me. Has anyone had a similar experience?