Will UMR Health Insurance Cover Bariatric Surgery in Nevada?
If you’re considering bariatric surgery, understanding what your health plan covers can help you avoid delays and unexpected costs. UMR is a third-party administrator for UnitedHealthcare that handles claims and coverage decisions for a wide range of employer-sponsored health plans. Because benefits can vary by plan, it’s important to verify the specific requirements and documents needed to obtain approval for weight loss surgery.
UMR plans may cover bariatric surgery when specific medical criteria are met and no plan-specific exclusions apply. Each request is reviewed individually, and approval is based on both the medical necessity of the procedure and the specific language in your benefit plan documents. Medical records and provider attestations are required for review, and coverage cannot be determined without them.
What Documentation is Required?
To move forward with a coverage request for bariatric surgery, UMR requires the following clinical information:
- Current height, weight, and BMI
- If BMI is between 35 and 39.9, medical documentation of at least one clinically serious obesity-related condition
- A pre-operative evaluation including BMI and weight history, physical activity and dietary patterns, or records showing participation in a multidisciplinary preparatory program
- A psychological evaluation ruling out major mental health disorders that could interfere with post-op care
- Confirmation of the ability to follow through with dietary and follow-up guidelines
- Verification that there are no medical contraindications to surgery
- If applicable, a list of prior treatments that were attempted, failed, or not tolerated, along with dates and reasons for discontinuation
- For staged procedures, information about the initial bariatric surgery, its date, and results or complications requiring additional surgery
- If relevant, provider verification of Asian ancestry
Providing this information in a concise and complete format helps avoid delays, denials, and the need to appeal.
Which Procedures Are Not Covered?
According to UnitedHealthcare’s medical policy, certain uses of bariatric surgery are considered unproven and may not be covered. These include:
- Bariatric surgery used to treat gynecological issues, osteoarthritis, gallstones, urinary stress incontinence, GERD, gastroparesis, Barrett’s esophagus, and other obesity-related conditions that typically do not result in life-threatening complications.
In addition, some procedures are listed as unproven for the treatment of obesity, including but not limited to:
- Transoral endoscopic surgery
- Mini gastric bypass
- Gastric electrical stimulation
- Vagus nerve blocking
- Intragastric balloon
- Gastrointestinal liners
- Greater curvature plication
It’s essential to review your specific plan language because UMR follows the coverage terms outlined in your benefit document. If your plan includes different criteria or exclusions, those will take precedence over general medical policy.
What Steps Should You Take?
Here’s how to prepare for your bariatric surgery request through UMR:
- Confirm your benefits and coverage requirements by reviewing your plan documents or calling UMR directly.
- Work with our VIPSurg administrative team to gather and submit the required clinical documentation.
- Make sure your psychological evaluation and weight management documentation are up to date and clearly recorded.
- Ask your healthcare team if any aspects of the proposed procedure could fall under the list of unproven or not-covered techniques.
- Keep records of all communication and documents submitted with UMR.
Have Questions? We Can Help.
Bariatric Insurance approval can feel complex, but you don’t have to handle it alone. Our team works with UMR regularly and can help you understand what your plan requires, what documents are needed, and how to move forward with confidence. If you need help coordinating the approval process or understanding your policy, VIPSurg is here to support you.
