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Coventry Health Care – Weight Loss Surgery Requirements

In Am I Covered by OC Staff

To qualify for coverage of weight loss surgery, your policy must include coverage. Not all policies include coverage. To find out if you policy includes coverage, please talk directly to Coventry Health Care.

Assuming your policy covers surgery, then you must meet the requirements below to qualify. It doesn’t appear that Coventry Health Care has posted the requirements for obesity surgery online but they offer a clear path to approval.

Coventry Health Care Requirements for Weight Loss Surgery

Coventry Health Care requires that you meet a certain criteria. Their public bariatric surgery benefit statement says,

“Bariatric surgery is a high risk procedure, and is generally performed only when less invasive methods of weight loss have failed and the patient is at high-risk for obesity-associated morbidity or mortality.”

What that means:

Basically, it means that you must have a serious risk to your health to qualify for weight loss surgery. This is known as a severe comorbidity. Check out our page on comorbidities for details, but illnesses such as diabetes, high blood pressure, and severe sleep apnea are considered severe comorbidities (life-threatening illnesses that are a result of obesity).

The Basic Qualifications:

Without knowing the specific qualifications for coverage, Coventry Health Care will definitely require the minimum that the National Institute of Health recommends as a qualification for weight loss surgery.

  • Body Mass Index of 40 or greater, OR
  • Body Mass Index of 35 or greater with at least 2 comorbidities
  • Over the age of 18

Procedures That Are Covered

If you qualify for surgery, the procedures below are covered.

  • Gastric bypass surgery
  • Lap gastric band surgery (Lap Band and/or Realize Band)
  • Gastric sleeve surgery
  • Duodenal switch surgery

Coverage Limits?

Based on the disclosure statement, Coventry Health Care covers up to $30,000 for your procedure. Consider checking with your bariatric surgeon on the total cost of surgery and ask Coventry Health if this is still the limit.

Where do I have Surgery?

Coventry Health Care makes it clear that you must have the surgery done by an approved Coventry Health Care Bariatric Surgeon. These surgeons are pre-screened to meet the criteria that Coventry Health specifies.

Who do I contact?

To get started with Coventry Health Care’s bariatric program you can call 1-800-272-8931 or visit their bariatric statement disclosure form.


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