How to Get Weight Loss Surgery With WA Teamsters Insurance
If you have Washington Teamsters Welfare Trust coverage, this page explains how bariatric surgery benefits typically work, what criteria your plan may require, and how Eviva can help you navigate the process.
Do WA Teamsters Medical Plans Cover Weight Loss Surgery?
The good news is that Washington Teamsters Welfare Trust medical plans can offer coverage for bariatric procedures such as gastric sleeve and gastric bypass when plan benefits, medical necessity criteria, Center of Excellence requirements, and preauthorization requirements are met.
Your coverage depends on the Trust medical plan you are enrolled in, your current eligibility, the applicable Summary Plan Description, Premera review, and whether care is scheduled through an approved bariatric Center of Excellence. Eviva can help verify your benefits before you begin the process.
Important Coverage Update
Effective July 1, 2025, the Trust's former pre-surgery program through Sound Health Connects (SHC) is no longer required to receive preauthorization for weight loss surgery.
You still need preauthorization through Premera BlueCross and must use an approved Center of Excellence (COE) for bariatric surgery. Eviva can help verify your current benefits, review plan-specific requirements, and identify the next step.
Procedures Covered by WA Teamsters Medical Plans: Preauthorization Required
The following summary reflects how WA Teamsters bariatric surgery benefits are typically described in Trust materials. Coverage should always be verified against the member’s current plan documents before care is scheduled.
| Procedure | Coverage Summary | Preauthorization | Notes |
|---|---|---|---|
| Gastric Sleeve Sleeve gastrectomy |
✓ Yes, when criteria are met | Required | May be covered when medical necessity criteria are met, preauthorization is approved, and surgery is performed through an approved Premera bariatric Center of Excellence. |
| Gastric Bypass Roux-en-Y gastric bypass |
✓ Yes, when criteria are met | Required | May be covered when medical necessity criteria are met, preauthorization is approved, and surgery is performed through an approved Premera bariatric Center of Excellence. |
| Other Bariatric Procedures Plan documents control covered services |
! Verify before scheduling | Required | The current Summary Plan Description and Premera preauthorization review determine which procedures qualify under your specific plan. |
Criteria for Insurance Coverage
WA Teamsters uses plan criteria to help determine whether bariatric surgery is medically necessary. This is a simplified patient-facing summary of the criteria commonly listed in Trust plan documents.
BMI Criteria
Severe obesity that has persisted for at least 5 years, defined as:
- BMI exceeding 40; or
- BMI greater than 35 with at least one of the following severe comorbidities:
- Coronary heart disease
- Clinically significant obstructive sleep apnea
- Medically refractory hypertension (blood pressure greater than 140/90 despite optimal medical management)
Age and Medical History Criteria
- Must be 18 to 60 years of age. Participants over age 60 are reviewed on a case-by-case basis.
- Must have had a medical evaluation and documented work-up to rule out underlying treatable causes of morbid obesity within the past year.
Conditions That May Prevent Approval
Plan criteria may exclude coverage when any of the following are present:
- ×Pregnancy or lactation
- ×Active substance abuse
- ×End-stage cardiovascular disease
- ×Severe or uncontrolled psychiatric disorders
- ×Anorexia
Additional Conditions That May Affect Eligibility
Additional clinical issues may also affect eligibility or require further review, including:
- !Bulimia nervosa or active binge eating disorder
- !Unstable medical condition
- !Kidney disease
WA Teamsters Bariatric Surgery Cost Structure
The WA Teamsters bariatric surgery benefit uses a separate cost-sharing structure from many other medical services. Verify your exact responsibility before scheduling care.
Paid by the Trust
The Trust pays 80% of covered bariatric surgical services when preauthorization is granted and surgery is performed at a Premera COE facility.
Paid by the Member
You pay 20% of covered bariatric surgical costs. This 20% applies even after you have met your annual coinsurance out-of-pocket maximum — the out-of-pocket maximum does not cap your bariatric cost share.
Deductible Applied
Bariatric surgery benefits are not subject to your plan deductible or copays. Your 20% share also does not count toward your plan's coinsurance annual out-of-pocket maximum.
How to Get Weight Loss Surgery Covered by WA Teamsters
These are the typical steps from benefit verification to preauthorization under current WA Teamsters bariatric surgery guidance.
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Verify your plan and benefits
Confirm which Trust medical plan you are enrolled in (Medical Plan A, B, Z, or JC28XL), whether bariatric surgery benefits are active, and what network or COE requirements apply. Eviva can help with insurance verification and explain the next step for your specific plan.
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Document BMI and medical history
Your physician needs to document your BMI, any qualifying comorbidities, and the duration of your obesity. They will need to complete a medical evaluation to rule out underlying treatable causes of morbid obesity. A physician referral and documented medical work-up completed within the past year are required.
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Schedule a consultation with a COE bariatric surgeon
Surgery may need to be performed at a Center of Excellence for bariatric surgery (Blue Distinction Centers+ designated facility). Eviva can help verify this requirement and identify whether your care can proceed through an approved pathway.
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Complete any required evaluations
Your surgical team will coordinate the required pre-operative evaluations, which typically include a psychological or behavioral health evaluation to confirm you are an appropriate surgical candidate. Note that as of July 1, 2025, the Sound Health Connects 24-week pre-surgery program is no longer required for authorization.
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Submit for preauthorization through Premera
Preauthorization is required before surgery. Your surgical team gathers the supporting documentation and submits the requested procedure to Premera BlueCross for medical necessity review. Approval must be obtained before surgery is scheduled.
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Schedule your surgery at the COE
Once preauthorization is granted, surgery can be scheduled at an approved COE facility. The Trust will pay 80% of covered surgical costs and you pay 20%, with no deductible applied to these services.
WA Teamsters Medical Plan Documents
WA Teamsters medical plans may share a similar surgical weight loss benefit structure, but deductibles, copays, network rules, Center of Excellence requirements, and other medical benefits vary by plan. Eviva can review your insurance information and verify your current bariatric surgery benefits.
The links below match the medical plan documents listed in the Trust's Forms & Resources library.
WA Teamsters Weight Loss Surgery FAQ
These answers are a general guide for WA Teamsters members considering bariatric surgery. Your own benefits, plan documents, COE requirements, and preauthorization decision control coverage.
Does Washington Teamsters Welfare Trust cover weight loss surgery?
Washington Teamsters Welfare Trust medical plans may include bariatric surgery benefits when eligibility criteria are met, preauthorization is obtained, and any required Center of Excellence pathway is followed. Eviva can help verify your current benefits before care is scheduled.
Do I still need to complete the Sound Health Connects pre-surgery program?
No. Effective July 1, 2025, the Trust's pre-surgery program through Sound Health Connects is no longer required to receive preauthorization for weight loss surgery. You still need preauthorization through Premera BlueCross and must use a Premera Center of Excellence facility.
What BMI do I need for WA Teamsters bariatric surgery coverage?
You need either a BMI exceeding 40, or a BMI greater than 35 combined with at least one severe comorbidity — coronary heart disease, clinically significant obstructive sleep apnea, or medically refractory hypertension (blood pressure greater than 140/90 despite optimal medical management). The obesity must also have persisted for at least 5 years.
What does the 80/20 cost structure mean?
The Trust pays 80% of covered bariatric surgical costs and you pay 20%. This split is not subject to your plan deductible or copays, and your 20% share does not count toward your coinsurance annual out-of-pocket maximum. The 80/20 split applies even if you have already met your out-of-pocket maximum for the calendar year — the out-of-pocket maximum does not reduce your bariatric cost share.
What is a Premera Center of Excellence for bariatric surgery?
COE facilities hold the Blue Distinction Centers+ designation through Premera BlueCross, awarded based on rigorous quality standards. Eviva is a Premera Center of Excellence (COE) facility. We provide a full range of bariatric care including surgical care, post-operative care, outpatient follow-up, and patient education, and have documented lower complication rates and fewer readmissions. Surgery performed at a non-COE facility is not covered by the Trust, even with preauthorization in hand.
What if my WA Teamsters plan has a different network option?
Network rules, preauthorization steps, and cost-sharing can vary by plan option. Eviva can help review your insurance information, confirm whether bariatric surgery benefits are active, and explain what to verify before scheduling care.
Can I have surgery at any hospital, or only at a Center of Excellence?
The Trust's plan documents state that services provided by a provider that is not part of the Premera Center of Excellence for bariatric surgery will not be covered. Eviva can help verify the COE requirement and determine whether your care can be scheduled through an approved pathway.
What age requirements does the Trust have for bariatric surgery?
You must be 18 to 60 years of age to qualify. Participants over age 60 are reviewed on a case-by-case basis and are not automatically excluded.
Ready to Verify Your WA Teamsters Benefits?
Eviva can help you confirm your Trust medical plan, clarify Center of Excellence requirements, explain what documentation you may need, and identify the next step in your preauthorization process.
Related Resources
These pages can help you learn more about procedure options and the broader bariatric surgery process.