Most major insurance plans in Virginia cover bariatric surgery when standard medical criteria are met. Individual employer contracts, however, can exclude bariatric surgery entirely, so we always run a benefits check before your consultation. Below is what we see most often, plan by plan.
Standard medical criteria
Almost every insurer starts from the same medical criteria: a BMI of 40 or higher, or a BMI of 35 or higher with at least one obesity-related condition such as type 2 diabetes, hypertension, sleep apnea, severe joint disease, or fatty liver disease. See our qualifications page for the full list.
Anthem Blue Cross Blue Shield of Virginia
Anthem BCBS of Virginia covers sleeve gastrectomy, Roux-en-Y gastric bypass, and revisional surgery under most plans. Typical requirements:
- Standard BMI criteria (40+, or 35+ with a comorbidity)
- 3- to 6-month physician-supervised weight-loss program with monthly documented visits
- Psychological evaluation
- Nutrition evaluation with a registered dietitian
Aetna
Aetna commercial plans typically cover sleeve gastrectomy and gastric bypass. Requirements usually include a 3-month supervised diet, a psychological evaluation, and documentation of prior weight-loss attempts. Aetna is one of the stricter payers on documentation, so we submit your supervised-diet records carefully.
Cigna
Cigna covers sleeve gastrectomy, gastric bypass, and duodenal switch under most plans. A 3-month supervised diet is usually required, along with the standard psychological and nutrition evaluations.
UnitedHealthcare
UnitedHealthcare covers the standard bariatric procedures for patients who meet BMI criteria. Supervised-diet requirements vary by employer plan — some require 6 months, some none at all. A benefits check is essential.
Medicare
Medicare covers sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch for beneficiaries with a BMI of 35 or higher and one obesity-related condition. Medicare does not require a supervised diet, which makes pre-authorization noticeably faster for Medicare patients. Surgery must be performed at a Medicare-approved facility, which we are.
Virginia Medicaid
Virginia Medicaid covers bariatric surgery for adult members meeting BMI criteria, with additional documentation requirements. Coverage details can change year to year, so we verify current requirements at the time of your consultation.
Self-pay and financing
If your plan excludes bariatric surgery — or if you would rather move faster than the supervised-diet timeline — self-pay is straightforward. We publish transparent bundled pricing and partner with Prosper® Healthcare Lending for monthly-payment financing.
How we handle the paperwork
Our office verifies your specific plan’s coverage, tracks the supervised-diet visits when required, gathers the psychological and nutrition evaluations, and submits the full pre-authorization packet on your behalf. Most approvals arrive within two to four weeks once the packet is complete.