How to Get Weight Loss Surgery With Uniform Medical Plan Insurance
If you're a Washington State employee or dependent with Uniform Medical Plan insurance, this page explains what bariatric surgery benefits UMP typically offers, what criteria you'll need to meet, and how Eviva can help you start the process.
Does UMP Cover Weight Loss Surgery?
The good news is that UMP plans do offer coverage for bariatric procedures such as gastric sleeve, gastric bypass, and some revision surgeries when medical necessity and documentation requirements are met.
Your copays, coinsurance, deductible, network rules, and out-of-pocket maximum depend on the specific UMP plan you are enrolled in. Coverage also depends on your member contract, the current medical policy, and the prior authorization decision.
Important Coverage Note
UMP uses Regence medical policy criteria for medical necessity review. Your member contract and current plan documents control the final coverage decision.
Current Regence bariatric surgery medical policy: DownloadProcedures Covered by UMP:
| Procedure | Coverage Summary | Preauthorization | Notes |
|---|---|---|---|
| Gastric Sleeve Sleeve gastrectomy |
✓ Yes, when criteria are met | Required | May be considered medically necessary when BMI, supervised program, behavioral health, and documentation criteria are satisfied. |
| Gastric Bypass Roux-en-Y gastric bypass |
✓ Yes, when criteria are met | Required | May be considered medically necessary when BMI, supervised program, behavioral health, and documentation criteria are satisfied. |
| Revision Surgery Certain reoperations or conversions |
✓ Yes, in qualifying cases | Required | May be covered for policy-defined complications or qualifying conversion scenarios. Documentation requirements are more specific for revision requests. |
| Endoscopic Sleeve Gastroplasty ESG / endoscopic gastroplasty |
× No, generally not covered | Not typically approved | Regence policy considers endoscopic procedures investigational as primary bariatric procedures. |
| Intragastric Balloons Gastric balloon systems |
× No, generally not covered | Not typically approved | Gastric balloon systems are listed among examples of endoscopic devices/procedures in the Regence bariatric surgery policy. |
Criteria for Insurance Coverage
UMP uses Regence medical policy criteria to help determine medical necessity for bariatric surgery.
BMI Criteria
At the start of the medically supervised weight reduction program, one of the following must generally be documented:
- BMI of 40 or higher; or
- BMI of 35 or higher with at least one qualifying obesity-related condition.
Qualifying conditions listed in the Regence policy include type 2 diabetes, poorly controlled hypertension despite optimal medical management, coronary artery disease, or obstructive sleep apnea with an AHI of 15 or greater per hour.
Additional Criteria
- At least 3 consecutive months in a structured, medically supervised pre-operative program within the 12 months before the surgery request.
- At least 2 medical supervision visits during that 3-month program, including one at the start and one at least 90 days later.
- Program supervision by an MD, DO, NP, PA, or registered dietitian in conjunction with the bariatric program.
- Include assessment and counseling related to weight, nutrition, diet, exercise, and behavior modification.
- Preoperative behavioral health evaluation by an eligible licensed professional.
- Clinical documentation that the patient is an appropriate candidate and committed to the treatment plan.
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Verify your UMP benefits
Eviva can help confirm whether your plan is UMP Classic, UMP Select, or UMP CDHP and identify deductible, coinsurance, network, and preauthorization requirements.
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Complete your consultation
Your surgeon will create your care plan and document your BMI as well as evidence of any qualifying obesity-related conditions.
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Complete the supervised pre-operative program
UMP/Regence criteria generally require a structured, medically supervised pre-operative program lasting at least 3 consecutive months.
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Complete behavioral health evaluation
The policy requires a preoperative evaluation documenting that there are no significant psychiatric issues that would limit understanding of the procedure or ability to comply with aftercare instructions.
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Submit for prior authorization
Eviva gathers the required information and submits the requested procedure and supporting documentation for insurance review.
2026 Uniform Medical Plan Options for Washington State Employees
As of 2026, Washington State employees may have three non-Medicare Uniform Medical Plan options: UMP Classic, UMP Select, and UMP CDHP. Your coverage level, deductible, coinsurance, and maximum out-of-pocket responsibility will vary depending on which plan you are enrolled in.
Uniform Medical Plan Weight Loss Surgery FAQ
These answers are a general guide for UMP members considering bariatric surgery. Your own benefits, medical policy criteria, and prior authorization decision control coverage.
Does Uniform Medical Plan cover weight loss surgery?
Uniform Medical Plan covers bariatric surgery when plan benefits, medical necessity criteria, documentation requirements, and prior authorization requirements are met. Member contracts and current plan documents control coverage decisions.
What BMI is usually required for UMP bariatric surgery coverage?
The Regence bariatric surgery medical policy criteria include BMI greater than or equal to 40, or BMI greater than or equal to 35 with at least one qualifying comorbid condition, such as type 2 diabetes, poorly controlled hypertension, coronary artery disease, or obstructive sleep apnea with AHI of 15 or greater.
Which procedures does UMP cover for weight loss surgery?
Sleeve gastrectomy and Roux-en-Y gastric bypass may be covered when BMI, supervised program, behavioral health, and documentation criteria are met — all require preauthorization. Revision surgery may also be covered for policy-defined complications. Endoscopic procedures, including ESG and intragastric balloon systems, are considered investigational under Regence policy and are generally not covered. Self-pay options are available for procedures your plan excludes.
Ready to Verify Your UMP Benefits?
Eviva can help you confirm whether your UMP plan includes bariatric surgery benefits, explain common documentation requirements, and identify the next step in your journey.
Related Resources
These pages can help you compare procedure options and understand the broader process for weight loss surgery care.