Obesity Surgery
The Plan covers surgical treatment of obesity provided by or under the direction of a Physician provided all of the following is true:
  • You have a minimum Body Mass Index (BMI) of 40 or 35 in conjunction with any other co-morbidity (i.e. coronary heart disease, type 2 diabetes, etc.);
  • You have documentation from a physician of a diagnosis of morbid obesity for a minimum of five years;
  • Patient has completed growth;
  • You have completed a six-month physician-supervised weight loss program.
Benefits for obesity surgery services are covered only if they meet the definition of a covered health service (see "Medical Plan Definitions") and are not considered experimental, investigational or unproven.
Prior Authorization Requirement
For out-of-network benefits you must obtain prior authorization from UnitedHealthcare as soon as the possibility of obesity surgery arises.
If you fail to obtain prior authorization from UnitedHealthcare as required, benefits will be subject to a $400 penalty.
It is important that you provide notification regarding your intention to have surgery. Your notification will open the opportunity to become enrolled in programs that are designed to achieve the best outcomes for you.