Bariatric Surgery

Covers bariatric surgery (e.g., Roux‑en‑Y gastric bypass, sleeve gastrectomy and other standard weight‑loss procedures) for morbid obesity—typically adults with BMI ≥40 kg/m² or BMI ≥35 kg/m² with at least one poorly controlled obesity‑related comorbidity, with requirements for persistent obesity, ≥6 months of failed physician‑supervised nonsurgical therapy and adolescent criteria (Tanner stage 4–5, near‑final height) where applicable. Coverage is contingent on the member’s benefit plan and meeting strict selection criteria, including a behavioral health evaluation by a master’s‑level provider within 12 months, documented surgeon education and patient agreement to comply with nutrition/behavior/exercise/post‑op care; exclusions apply per contract, age <21 limits except life‑saving cases, and some procedures/indications are deemed investigational or not medically necessary.

"Nonexperimental surgical treatment of morbid obesity when BMI ≥35 with at least one comorbidity (e."