How does the Body Mass Index (BMI) relate to how UMP decides whose bariatric surgery will be covered?

What does BMI mean?

The Body Mass Index (BMI) is a measurement of the ratio between height and weight. Those with a BMI of more than 25 generally have excess body fat in addition to being overweight for their height.

The World Health Organization (WHO) uses the following definitions for the obese category:

Severely Obese = BMI 35 - 39

Morbidly Obese = BMI 40 - 50

Super Obese = BMI over 50

Why does UMP require a BMI of 40 or more as part of its criteria for coverage of bariatric surgery?

Bariatric surgery is for the morbidly obese, which is defined as having a BMI of 40-50.

What if I am in the Super Obese category (BMI greater than 50)?

You may still qualify and can apply for coverage; however, because of the increased risks involved by being in this high-risk category, you may require special expertise or other specific services.

What are the criteria enrollees must meet to be considered for coverage of obesity surgery?
Bariatric Surgery Criteria for Coverage To be considered for coverage of bariatric surgery, members must meet the following criteria. They also must comply with all presurgical requirements set by UMP through case management, including enrolling in and pay More
How often can I apply for bariatric surgery?
You can apply no more than once every calendar year. If you are accepted into the presurgical program but do not proceed with the surgery for whatever reason, you may not apply again for three calendar years. If you drop out of the presurgical program or d More
Is follow-up surgery to remove loose skin covered by the plans (UMP Classic or UMP CDHP)?
Panniculectomy (removal of loose skin) is covered following bariatric surgery for a medical condition only when specific medical criteria are met (contact Customer Service at 1-888-849-3681). Most panniculectomies are considered cosmetic and are not covere More
How long is the process to qualify for bariatric surgery under UMP Classic or UMP CDHP?
The amount of time it takes will depend a lot on you. You are required to lose 5 percent of your initial verified body weight within six months after being accepted into the program. You will not be referred to a Center of Excellence for evaluation until y More
How does case management for bariatric surgery work?
Candidates for bariatric surgery are required to work with case managers to prepare for surgery. This is major, high-risk surgery, and UMP wants to ensure that members have the information they need to make an informed decision. Your case manager will: Per More
Why am I limited to the providers chosen by UMP for bariatric surgery?
UMP’s clinical group and medical directors reviewed current standards of care, as well as the recommendations of professional societies and organizations that certify bariatric surgery providers. In developing our criteria for coverage of bariatric s More
Obesity Management (Bariatric Surgery)
Find Out More For more information about qualifying for bariatric surgery, see Related Items below. NOTE: The plans refers to UMP Classic and UMP CDHP. Which surgeries are covered? Because of the high-risk nature of bariatric surgery, the plans cover j More
How to Request Coverage of Obesity Surgery
The first step in requesting coverage for either bariatric surgery is to fill out the Request for Bariatric Surgery Coverage questionnaire . The questionnaire asks about your current weight, medical history, and medications you currently take. A case manag More
Weight Control Resources
The following list of resources have been reviewed and approved by your plan's clinical staff. Providing this list does not imply that the plan covers services recommended on these sites. All of the below are external links and not part of the UMP web More
Initial Application for Bariatric Surgery Consideration
Completing and submitting this application is considered a request for coverage. You may apply only once per calendar year . You can fill out this application online and click 'submit' OR download the form (123K) , print and mail it to: Obesity More
Services related to bariatric surgery not covered by the plans (UMP Classic or UMP CDHP)
The plans do not cover the following services: Bariatric surgery for persons under age 18. Coverage of follow-up care or complications following any bariatric surgery procedure other than Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding More
What is Accomplish Bariatric Nutrition Services?
Enrollees who apply for and meet the initial coverage criteria for bariatric (obesity) surgery must pay for and participate in the Accomplish Bariatric Nutrition Services program . Accomplish provides a specialized nutrition program developed by local bari More
Bariatric surgery and Medicare coverage
TIP: The following information assumes that Medicare would be your primary coverage as of age 65. It does not apply to those for whom Medicare is secondary, which may be the case if you are an eligible dependent of an employee (rather than a retiree). I am More
Bariatric surgery: When reoperation or revision may be covered.
Under what circumstances might reoperation be covered? Reoperation to address certain complications following bariatric surgery may be covered, including but not limited to: Staple-line failure Obstruction Stricture Non-absorption resulting in hypoglycemia More
Coverage of Bariatric Surgery
Bariatric (obesity) surgery is covered only in very specific clinical circumstances, including co-morbid conditions, and must be preauthorized by the plan. The plan will cover the surgery only if the patient meets all program requirements, including those More

The certificate of coverage (COC) for the member's plan (UMP Classic or UMP CDHP) is the source of coverage provisions offered under the plans. If information given here is inconsistent with the applicable COC, the rules in the COC will apply. Also, the COC may have additional information on this subject.

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