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, sleeve gastrectomy, or laparoscopic adjustable gastric banding surgery.
  • Coverage of follow-up care or complications when the surgery was not covered by UMP or another health plan, or the patient would not have qualified for bariatric surgery coverage under UMP.
  • Dietary programs, including any weight-loss program associated with bariatric surgery, for any purpose except as stated under "Coverage of nutrition therapy."
  • Panniculectomy or removal of excess skin except for specific medical conditions.
  • Services performed during a noncovered service.
  • Services performed primarily to ensure the success of a noncovered service, including but not limited to a hiatal hernia repair done to ensure the success of a noncovered Laparoscopic Adjustable Gastric Banding surgery.
  • Weight control, weight loss, and obesity treatment:
    • Non-surgical: Any program, drugs, services, or supplies for weight control, weight loss, or obesity treatment. Exercise or diet programs (formal or informal), exercise equipment, or travel expenses associated with non-surgical or surgical services are not covered. Such treatment is not covered even if prescribed by a provider.
    • Surgical: Any bariatric surgery procedure, any other surgery for obesity or morbid obesity, and any related medical services, drugs, or supplies, except if approved through case management as described under "Bariatric Surgery."