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 counseling and 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, except as covered under "Diabetes Prevention Program,"  "Nutrition Counseling and Therapy," or "Preventive Care."
    • Surgical: Any bariatric surgery procedure, any other surgery for obesity or morbid obesity, and any related medical services, drugs, or supplies, except when approved by preauthorization review.