CHAMPVA – Requirements for Weight Loss Surgery

CHAMPVA covers weight loss surgery. 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 CHAMPVA.

The US government understands that weight loss surgery is a life saving procedure and if you meet the requirements and your policy includes coverage then your surgery will be covered by CHAMPVA insurance.

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CHAMPVA Pre-Approval Requirements

CHAMPVA covers weight loss surgery when you meet the requirements below:

• The patient has completed growth (18 years or older).
• The patient has previously been unsuccessful with weight loss surgery. You must have documented proof that you tried and were unsuccessful with medically supervised weight loss programs.
  • These can include programs like Jenny Craig, Weight Watchers,
• The patient must have a Body Mass Index of 40 or greater; or
• The patient must have a Body Mass Index of 35 to 39.9 and at least one comorbidity that can include:
  • cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension

Types of Weight Loss Surgeries Covered by CHAMPVA

1. Gastric Bypass Surgery
2. Vertical Banded Gastroplasty
3. Lap Band Surgery

CHAMPVA may also cover gastric sleeve surgery. Contact CHAMPVA directly to inquire about this surgery. Which surgery is right for you?

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Are Lap Band Fills Covered?

Yes, Lap Band and Realize Band fills are covered if your original surgery was covered by insurance. If you paid out-of pocket because you didn’t qualify for insurance coverage, you may also have to pay out of pocket for the lap band fills.

Is a second weight loss surgery covered if the first one doesn’t work?

A second procedure is covered if:

1. You develop a complication as the result of the original surgery. Such as a stricture or leak.
2. If you have gastric band surgery and you develop a complication such as the port leaking or the band slipping, then a second procedure is covered.
3. If your first procedure doesn’t work (you don’t lose enough weight or regain it) then another procedure will be covered if:
   1. The patient has failed to achieve adequate weight loss, which is defined as failure to lose at least 50% of excess body weight or failure to achieve body weight to within 10% of ideal body weight at least two years following the original surgery.
   2. The patient meets all of the original criteria again.
   3. The new procedure is a procedure that is covered by CHAMPVA (see above).
   • Note: If you do not lose weight because you do not comply with post-operative diet and exercise guidelines then you will not be eligible for a second procedure.

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Does CHAMPVA require you have surgery at a Center of Excellence?

No, but you will have to have surgery at a VA facility.

What procedures are excluded?

• Non-surgical treatments for weight loss. These include, weight loss devices, gym memberships and programs such as Jenny Craig, etc..
• Biliopancreatic bypass.
• Sleeve Gastrectomy.
• Any unproven weight loss surgeries or experimental procedures.

Contact CHAMPVA

To contact CHAMPVA you can visit their site to either email or call them.

CHAMPVA’s Full Weight Loss Surgery Policy

CHAMPVA’s full policy can be found here.

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