I was only at a BMI of 42 when I started the process in march 2016 and was told to try and lose weight that the weight submitted to my insurance company was my weight from my first visit not the weight right before surgery. So even if I lost 30 lbs and went below the 40 BMI mark I would still be approved by my insurance because they wouldn't be the wiser to the fact that I had lost weight to go below that.