Anthem publishes its rules in Clinical UM Guideline CG-SURG-83, "Bariatric Surgery and Other Treatments for Clinically Severe Obesity." Below a BMI of 35, Anthem considers bariatric surgery not medically necessary. The clinical thresholds are standard; the documentation of prior conservative treatment is where requests most often fall short.
Anthem generally covers these as medically necessary when criteria are met:
Anthem generally does not cover the intragastric balloon (gastric balloon) and similar newer procedures, treating them as investigational or not medically necessary.
Anthem uses the long-standing thresholds:
This is a higher bar than Cigna, which covers surgery at BMI 35 alone (or 30 with a condition). See how Cigna compares →
Anthem wants evidence you've genuinely tried before surgery, plus a full pre-surgical workup. Expect to need:
| Insurer | BMI alone | BMI with a condition | Notable requirement |
|---|---|---|---|
| Anthem / Elevance | ≥40 | ≥35 | Documented conservative therapy + evaluations (CG-SURG-83) |
| Cigna | ≥35 | ≥30 | Lower BMI bar; no fixed multi-month diet |
| Aetna | ≥40 | ≥35 | Evaluations + a supervised program |
| UnitedHealthcare | ≥40 | ≥35 | Often a designated facility + program |
| Medicare | — | ≥35 + a condition + failed medical treatment | No BMI-alone path |
Enter your BMI, conditions, and plan, and see exactly where you stand against Anthem's real criteria — plus what to document to support approval.
Check my bariatric coverageYes. Sleeve gastrectomy is covered by Anthem as medically necessary when you meet the criteria — generally a BMI of 40 or higher, or 35 or higher with a weight-related condition — plus documented conservative therapy and the required evaluations.
Yes. Roux-en-Y gastric bypass is a covered procedure under Anthem's CG-SURG-83 guideline, subject to the same BMI thresholds and pre-surgical requirements as the gastric sleeve.
Anthem uses a BMI of 40 or higher on its own, or 35 or higher with a weight-related condition. Below a BMI of 35, bariatric surgery is generally considered not medically necessary. That is a higher bar than Cigna, which covers surgery at a BMI of 35 alone or 30 with a condition.
Anthem wants documented conservative therapy — a genuine attempt at diet, exercise, and behavioral change with inadequate weight loss — along with nutritional and psychological evaluations and pre-operative education. The specifics can vary by plan, so confirm your plan's requirement.
Generally no. Anthem typically treats the intragastric balloon (gastric balloon) as investigational or not medically necessary, so it is usually not covered. A covered procedure such as the sleeve or bypass is the more likely path.
The most common reasons are missing documentation of conservative therapy, incomplete evaluations, a chosen procedure Anthem considers investigational, or an employer plan that excludes bariatric surgery entirely. Documenting the conservative-care attempt up front prevents most denials.
Related: Weight-loss coverage — the full guide · Cigna · Aetna · UnitedHealthcare · Medicare · coverage checker