Bariatric Surgery – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers established bariatric surgeries—Roux‑en‑Y gastric bypass (including robotic), sleeve gastrectomy, biliopancreatic diversion/duodenal switch, and adjustable gastric banding (adults ≥18)—when medically necessary, and considers many endoscopic and newer procedures/devices (e.g., intragastric balloons, bariatric artery embolization, VBLOC, EndoBarrier/gastrointestinal liners, mini/OAGB, SADI‑S, endoscopic sleeve gastroplasty, AspireAssist, transoral devices) unproven and not medically necessary. Coverage requires documented BMI thresholds (generally ≥40 or ≥35 with qualifying comorbidities, with select consideration for BMI 30–34.9 with T2D), detailed preoperative weight history and objective testing, a psychosocial or multidisciplinary surgical evaluation (MBSAQIP‑accredited or equivalent for adolescents), evidence of failed conservative management, and strict limits on revisional and planned two‑stage procedures (revisions only for specified technical failures/major complications; second stage within 2 years with demonstrated compliance).