For years, many Arkansas patients who could benefit from bariatric surgery faced a frustrating obstacle: their health insurance simply would not cover the operation.

Even patients struggling with severe obesity, diabetes, high blood pressure, or obstructive sleep apnea sometimes discovered that their insurance would pay for the complications of obesity but not for surgery intended to treat the underlying disease.

That changed for many patients on January 1, 2026.

Arkansas Act 628 now requires state-regulated, fully insured health plans to cover medically necessary bariatric surgery for eligible adults with a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater with an associated medical condition such as diabetes, hypertension, or sleep apnea.

If you were previously told that your insurance does not cover gastric sleeve or gastric bypass surgery, it may be time to check your benefits again.

Verify Your Bariatric Surgery Insurance Benefits Through UAMS Health

Dr. Samuel Bledsoe, a bariatric surgeon practicing in Arkansas since 2009, was the principal architect of the initiative that became Act 628. Building on his earlier leadership in expanding bariatric surgery coverage for Arkansas state and public school employees, he worked with legislators, physicians, and other stakeholders to make surgery more accessible to Arkansas patients.

For more about the legislative effort behind Act 628, including committee testimony and the history of bariatric surgery coverage in Arkansas, see Dr. Bledsoe’s Healthcare Advocacy & Leadership page.

Although Act 628 represents a significant expansion of insurance coverage, it does not apply to every health plan. Understanding who qualifies and what the law requires is an important first step.

What Is Arkansas Act 628?

Arkansas Act 628, originally introduced as House Bill 1424, requires qualifying insurance plans to cover medically necessary treatment for severe obesity.

Sponsored by Representative Lee Johnson and Senator Blake Johnson, the legislation was signed into law on April 16, 2025, and took effect January 1, 2026.

The law addresses a longstanding problem in obesity treatment: insurance companies sometimes covered years of medications and medical care for obesity-related diseases while excluding bariatric surgery.

For example, an insurance policy might cover diabetes medications, treatment for hypertension, and equipment for sleep apnea while refusing to cover an operation that could substantially improve those conditions.

Act 628 makes bariatric surgery a required covered benefit for eligible patients under qualifying insurance plans.

Importantly, the legislation covers more than the operation itself. It also includes appropriate preoperative evaluation, nutritional counseling, psychological services, and postoperative follow-up.

Who Qualifies for Bariatric Surgery Under Act 628?

The law establishes specific BMI requirements for severe obesity.

Under the private insurance provisions, patients meet the BMI definition with either:

• A BMI of 40 or greater, regardless of associated medical conditions.
• A BMI of 35 or greater, with at least one associated obesity-related medical condition.

The law specifically identifies diabetes, hypertension, obstructive sleep apnea, and cardiopulmonary conditions. Other associated conditions may also be recognized under applicable medical necessity standards.

For perspective, a person who is 5 feet 6 inches tall reaches a BMI of approximately 35 at 217 pounds and a BMI of approximately 40 at 248 pounds.

Patients must be at least 18 years old to qualify under the private insurance mandate.

What if Your BMI Is Below 35?

Some patients with a BMI below 35 may still benefit from metabolic surgery.

The 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recognize that surgery may be appropriate for selected patients with a BMI between 30 and 35, particularly those with metabolic disease.

However, medical eligibility for bariatric surgery and insurance coverage are not always identical.

Patients who fall below Act 628’s BMI thresholds may still be appropriate surgical candidates, but coverage depends on their individual insurance policy.

Not sure whether your BMI or medical conditions make you a candidate for bariatric surgery? I’ve also written a guide explaining the current medical recommendations, Arkansas eligibility requirements, and how your previous weight-loss efforts may affect your options. Read Do I Qualify for Bariatric Surgery in Arkansas?

Which Arkansas Insurance Plans Are Covered by Act 628?

This is one of the most important distinctions in the new law.

Act 628 applies to qualifying private health insurance plans regulated by Arkansas. It does not automatically apply to every insurance policy held by an Arkansas resident.

Arkansas Bariatric Surgery Insurance Coverage at a Glance

Fully Insured vs. Self-Funded Insurance

Many Arkansas employers purchase traditional, fully insured health insurance policies in which the insurance company assumes responsibility for paying medical claims.

These plans are generally subject to Act 628.

Other employers operate self-funded plans, meaning the employer pays medical claims directly while an insurance company may administer the benefits.

Most private-sector self-funded employer plans are governed by federal ERISA law and are not subject to Arkansas insurance coverage mandates.

A patient may have an Arkansas Blue Cross and Blue Shield or UnitedHealthcare card without realizing that the employer, rather than the insurance company, is funding the plan.

The insurance company’s name alone does not determine whether Act 628 applies.

If you are uncertain, ask your employer’s human resources department:

Is our health plan fully insured or self-funded?

You can also check your plan documents or request an insurance benefits review.

Even when Act 628 does not apply, some employers voluntarily provide bariatric surgery coverage.

Arkansas State Employees and Public School Employees

Arkansas state employees and eligible public school employees have separate bariatric surgery benefits established before Act 628.

Through Act 109 of 2022, bariatric surgery became an ongoing covered benefit for qualifying members of the state’s employee and public school health plans beginning in 2023.

Dr. Bledsoe was a principal driving force behind this earlier legislation, which helped establish the medical and financial case for expanding coverage more broadly.

These plans have their own eligibility and authorization requirements through ARBenefits.

Arkansas Medicaid and Medicare

Act 628 contains a separate provision directing Arkansas Medicaid to reimburse for bariatric surgery and associated preoperative and postoperative care.

Medicaid has its own clinical criteria, documentation requirements, and authorization procedures.

Medicare is governed by federal rules rather than Act 628, but already provides bariatric surgery coverage for certain eligible patients.

Patients should not assume they lack bariatric surgery coverage simply because Act 628 does not apply directly to their insurance.

Check Your Insurance Coverage Through UAMS Health

What Bariatric Procedures Does Act 628 Cover?

The private insurance provisions specifically identify four bariatric operations:

• Sleeve gastrectomy (gastric sleeve)
• Roux-en-Y gastric bypass
• Biliopancreatic diversion with duodenal switch
• Laparoscopic adjustable gastric banding

The law also includes certain revisional bariatric procedures when necessary to correct complications from previous operations.

Coverage extends to appropriate preoperative and postoperative care, including nutritional counseling, behavioral support, psychological services, and follow-up.

The most appropriate surgical procedure depends on the patient’s medical history, obesity-related conditions, and treatment goals.

Learn more about bariatric surgery services in Little Rock and Bryant, Arkansas.

Does Act 628 Require Six Months of Supervised Dieting?

No. Act 628 limits the preoperative preparation period that a qualifying insurer may require to no more than three months.

Historically, some insurance companies required six months or longer of supervised dieting before approving bariatric surgery.

These requirements often delayed care for patients who had already spent years attempting to lose weight.

Under Act 628, insurers may require a preoperative period involving nutritional education, counseling, and other preparatory services, but that insurer-imposed period cannot exceed three months under the statute.

Importantly, three months is a maximum, not a mandatory waiting period for every patient.

Patients must still complete appropriate medical evaluations, receive education about surgery, and satisfy required documentation.

The law requires a healthcare provider’s written order addressing BMI, associated medical conditions, the treatment plan, and medical necessity. It also establishes preparation attestations, with an alternative pathway involving a multidisciplinary surgical preparation program.

Insurance companies may still require prior authorization and may restrict coverage to appropriately accredited bariatric surgery facilities.

The total time required to prepare safely for surgery varies from patient to patient.

Does Act 628 Cover Revisional Bariatric Surgery?

In certain circumstances, yes.

Some patients develop complications after previous bariatric surgery that require additional treatment.

For example, patients who underwent sleeve gastrectomy may develop persistent or severe gastroesophageal reflux disease (GERD).

When severe reflux does not respond adequately to medical treatment, conversion from sleeve gastrectomy to Roux-en-Y gastric bypass may be appropriate.

Act 628 includes provisions for revision surgery when necessary to manage complications from certain previous bariatric procedures.

However, a second bariatric operation performed solely because of weight regain is not automatically covered under Act 628.

The reason for revision, previous operation, medical necessity, and insurance requirements must all be considered.

Patients experiencing persistent reflux after sleeve gastrectomy can learn more in Dr. Bledsoe’s article, Severe Acid Reflux After Gastric Sleeve Surgery.

Does Act 628 Cover Ozempic, Wegovy, or Zepbound?

No. Act 628 does not require insurance companies to cover medications prescribed for weight loss.

The legislation specifically excludes mandatory coverage for injectable glucose-lowering medications and other medications prescribed for weight reduction.

However, individual insurance policies may cover some of these medications under separate prescription benefits.

Weight-loss medications and bariatric surgery can both be effective treatments for obesity. The appropriate choice depends on a patient’s medical conditions, treatment goals, and preferences.

Does Insurance Coverage Mean Bariatric Surgery Is Free?

Not necessarily.

Even when bariatric surgery is covered, patients may still be responsible for deductibles, coinsurance, and other expenses.

One issue has involved certain Arkansas marketplace and ARHOME insurance plans.

Published 2026 benefit information from Arkansas Blue Cross and Blue Shield identifies a separate $25,000 deductible for certain non-essential health benefits, including bariatric surgery.

That can create a significant financial barrier even when the operation is technically covered.

However, this deductible does not apply to every Arkansas insurance plan, and individual cost-sharing requirements vary.

What About ARHOME Coverage in 2027?

Arkansas’s ARHOME Medicaid demonstration is currently scheduled to expire December 31, 2026, and its future remains unresolved.

The state and federal government are considering the program’s future, including potential changes to its structure and coverage arrangements.

As of October 2026, patients should not assume that their ARHOME coverage, deductible, or bariatric surgery benefits will remain the same—or change in any particular way—in 2027.

Patients currently enrolled in ARHOME should verify their existing benefits and review official notices about future coverage before making decisions based on anticipated program changes.

Choosing Health Insurance for 2027?

Open enrollment for 2027 coverage through the federal Health Insurance Marketplace begins November 1, 2026, and ends January 15, 2027. Enrollment by December 15 generally allows coverage to begin January 1.

Before selecting a plan, patients considering bariatric surgery should ask:

• Does this policy cover gastric sleeve or gastric bypass surgery?
• Is there a separate bariatric surgery deductible?
• What are the applicable out-of-pocket costs?
• Is the preferred bariatric surgeon and operating facility in-network?
• What prior authorization and preparation requirements apply?

A plan that lists bariatric surgery as a covered benefit is not necessarily the plan with the lowest out-of-pocket cost.

Verify Your Current Bariatric Surgery Benefits Through UAMS Health

Why Dr. Bledsoe Worked to Expand Bariatric Surgery Coverage in Arkansas

Dr. Samuel Bledsoe has practiced bariatric surgery in Arkansas since 2009 and has played a central role in two major efforts to expand insurance coverage for patients with severe obesity.

He was a principal driving force behind Act 109 of 2022, which established ongoing bariatric surgery benefits for eligible Arkansas state and public school employees, and the principal architect of the initiative that became Act 628 of 2025, expanding mandated coverage to qualifying private insurance plans.

The earlier state employee program provided important evidence supporting broader coverage. Data presented to legislators demonstrated substantial reductions in medical expenditures following bariatric surgery, including an approximately 45% reduction in medical costs per member per month among surgical patients in the analysis.

Building on that experience, Dr. Bledsoe organized physicians and other stakeholders, coordinated financial and legislative support, helped secure legislative sponsorship, and testified before legislative committees about the medical and economic benefits of bariatric surgery.

Representative Lee Johnson and Senator Blake Johnson sponsored Act 628, which was signed into law on April 16, 2025.

In Dr. Bledsoe’s Words

“Over the years, I cared for many patients who were medically appropriate candidates for bariatric surgery but could not proceed because their insurance policies excluded the treatment.

I believed that needed to change. I worked to bring together the physicians, stakeholders, resources, and legislative support necessary to expand coverage, first for state and public school employees and then for patients with qualifying private insurance.

My goal was straightforward: patients with severe obesity should have a reasonable opportunity to receive medically necessary treatment without unnecessary insurance barriers.

I am grateful to Representative Lee Johnson, Senator Blake Johnson, and everyone who helped make these changes possible.”

Watch Dr. Bledsoe’s Testimony Before the Arkansas Senate

On April 3, 2025, Dr. Bledsoe testified before the Arkansas Senate Insurance and Commerce Committee in support of House Bill 1424, which subsequently became Act 628.

Watch Dr. Bledsoe’s Senate Testimony →

The recording offers an opportunity to hear firsthand about the medical and policy considerations behind expanding bariatric surgery coverage in Arkansas.

Bariatric Surgery at UAMS Health in Bryant, Arkansas

Dr. Samuel Bledsoe is a board-certified general and bariatric surgeon and holds a Focused Practice Designation in Metabolic and Bariatric Surgery from the American Board of Surgery.

He serves as Professor of Surgery at UAMS and Medical Director of Bariatric & Metabolic Surgery at UAMS Health in Bryant.

Dr. Bledsoe performs sleeve gastrectomy, Roux-en-Y gastric bypass, and revisional bariatric surgery for patients experiencing complications after previous weight-loss operations.

Patients from Little Rock, Bryant, Benton, Hot Springs, Conway, and throughout Arkansas can request an insurance benefits review and consultation.

During the initial evaluation, Dr. Bledsoe reviews the patient’s medical history, previous weight-loss efforts, obesity-related conditions, and treatment goals to determine whether surgery may be appropriate.

Learn more about his bariatric and metabolic surgery services at UAMS Health in Bryant.

Verify Your Insurance & Request a Consultation

If you were previously told that your insurance does not cover bariatric surgery, or if you are considering surgery for the first time, begin with the secure UAMS insurance verification form.

The insurance verification team can review your benefits and aims to contact patients within 72 hours to discuss coverage and next steps.

Verify Insurance & Request Consultation

Interested in seeing Dr. Bledsoe? Select him as your preferred surgeon when completing the form.

Prefer to call? (501) 252-6650

UAMS Health Specialty Clinic in Bryant
1901 Encore Way
Bryant, AR 72019

If insurance coverage prevented you from pursuing bariatric surgery in the past, Arkansas Act 628 may have changed your options. Checking your current benefits is an important first step.

References

1. Arkansas Act 628 of 2025 — Official Legislation. Arkansas General Assembly.
2. House Bill 1424 — Legislative History and Hearing Record.
3. Arkansas Act 109 of 2022.
4. Arkansas Blue Cross and Blue Shield — 2026 ARHOME Benefit Summary.
5. CMS — Arkansas ARHOME Demonstration Status.
6. HealthCare.gov — Open Enrollment Dates and Deadlines.
7. Eisenberg D, Shikora SA, Aarts E, et al. 2022 ASMBS/IFSO Indications for Metabolic and Bariatric Surgery. Surgery for Obesity and Related Diseases. 2022;18(12):1345–1356.

This article provides general medical and insurance information. Coverage and prior authorization depend on individual policies, current program rules, and medical necessity determinations.