According to WHO guidelines, if the BMI is greater than 35, then a person is morbidly obese. Bariatric surgery is an operation that helps obese people lose weight. The cost of bariatric surgery in India ranges between Rs. 2 to Rs 5 lakhs, and the implants alone cost around Rs. 1.25 lakhs.
Overcoming obesity may require more than just a healthy diet and exercise. Bariatric surgery can be a logical solution at such times. The good news is that health insurance companies already offer bariatric surgery benefits, or you can get bariatric surgery insurance with your health insurance company. Here is an overview of the importance of bariatric surgery and details about Insurance.
Scope of Insurance coverage for bariatric surgery in India:
Besides a few general insurance companies (referred to as insurers), obesity and allied health conditions were treated as exclusions, meaning they were not covered under health insurance. Surgical interventions that do not directly contribute to your health are excluded from health insurance. For example, liposuction is aimed at losing weight. However, they are considered cosmetic surgeries, which are excluded under health insurance policies.
On the other hand, bariatric surgery is recommended for obese patients who are suffering from other co-morbid health conditions brought about by obesity. It is this understanding that led to a few insurers to cover bariatric surgeries as well. This situation is bound to change with the intervention of IRDA.
IRDA (Insurance Regulatory and Development Authority), the Apex body governing general insurance business in India, has, vide its circular, proposed that all insurance companies to cover bariatric surgery in all its retail and group health products. Such coverage has to meet certain criteria as detailed by the regulatory, which shall be discussed below.
To whom is bariatric surgery suitable?
Bariatric surgery is suitable for those people whose BMI is over 40. It is also ideal for persons with a family history of obesity or has a tendency to gain unusual weight within a short period of time.
What procedures can be performed under bariatric surgery?
The below standard procedures form part of bariatric surgery:
Conditions laid down by the regulatory body for covering Bariatric Surgery under health insurance?
To cover bariatric surgery costs by your health insurer, all of the following conditions must be satisfied:
- The surgery needs to be backed up by all medical and diagnostic testing.
- Your treating physician must recommend surgery.
- The insured person who undergoes surgery must be at least 18 years of age.
- BMI should be > = 40
- BMI >= 35, and suffering from obese-related comorbid conditions such as coronary heart disease, sleep apnea, uncontrollable type-2 diabetes, and liver diseases etc.
Bariatric surgery as a modality for cosmetic and/or aesthetic reasons is not covered under health insurance.
IRDA in a statement confirmed that all state-owned and private insurers in India have to cover weight loss surgery to first time customers buying health insurance policies after October 1, 2019 and for all the existing customers from October 1, 2020.
What other costs are covered by health insurance apart from the weight loss procedure cost?
Surgery is not a standalone procedure. Surgery needs to be preceded by diagnostic tests such as MRI, blood work, scans etc. Pre and post operative care are as important as the procedure itself. Generally, a standard health insurance covers 30 days of pre-operative costs which includes doctor’s visitation charges, medication, and diagnostic testing; and 60 days of postoperative costs which again include followup visits to doctor, medication, and diagnostic testing.
Do patients have to pay extra to use Bariatric Surgery Insurance?
As discussed earlier, only a handful of insurers in India are covering weight loss procedures as part of emergency medical procedures by charging additional premium (insurance cost). This scenario is going to change with IRDA (the regulator) stepping in and advising all insurance companies to modify their health products to accommodate weight loss procedures. With this, all insurance companies are going to engage their actuarial department to make the modifications and also the premium to be charged for the coverage. Upon their internal deliberations, an insurer will have to file the same with the regulator and then use it to market it to the public.
All the interest parties (hospitals, doctors, public, and insurance companies) are going to have to wait for further clarifications.
Is there a waiting period for bariatric surgery insurance?
Yes, bariatric surgery in health insurance usually has a waiting period of 2 to 4 years, depending on the insurance company (insurer). This means that if you want to cover bariatric surgery costs, you will have to wait two years from the start of your policy. Therefore, it is always advisable to choose such a service when you have your first health insurance.
What will happen to your benefits of bariatric surgery if you change your health insurance provider?
To avail weight-loss surgery, one has to have a continuous health insurance coverage of 2 to 4 years, depending on the insurance company (insurer). As per the IRDA, porting from one insurance company to the other does not have any impact on your continuity benefits. For example, a person who has had health insurance from Insurer A for more than 4 years when ports his health insurance to Insurer B, he shall not forego his 4 plus years of seniority and that seniority shall be transferred to Insurer B. However, after porting to Insurer B for a higher sum insured value, then the difference in sum insured warrants waiting period.
What documents are required for the use of bariatric surgery in health insurance?
Documented detailed history of obesity-related health problems, difficulties, and attempts at treatment is needed, which suggests that a multidisciplinary approach to diet, other lifestyle changes (such as exercise and behaviour change) has been used, pharmacological therapy if any had not worked in at least the last six months.
Conclusion:
Claims arising from conditions that commence within 30 days of policy commencement are not covered. Claims for existing conditions are also not covered. The best way to benefit from bariatric surgery on your health insurance is to do proper research before choosing health insurance. Dr Venu Gopal Pareek in Hyderabad Best Bariatric surgeon accepts Insurance for bariatric surgery. For more information, call us on +91 91-777-77715.
