Health Insurance for Bariatic Surgery

If you are thinking that bariatric surgery is a solution to your weight loss management struggles, then the most important question will be whether the procedure is covered by your health insurance or not. Bariatric surgery is an important step towards a better lifestyle and health, but you have to be aware of the financial aspect as well. Though some companies provide coverage for bariatric surgery, some do not.

This article delves into the topic of bariatric surgery covered by insurance, helping you navigate the complex world of health insurance and its relation to the weight loss procedure.

What is Bariatric Surgery?

Bariatric surgery or weight loss surgery is a medical procedure designed to help people struggling with obesity. The surgery involves some techniques, such as gastric bypass, gastric sleeve, and gastric banding. It modifies the size of the stomach and its connection to the small intestine. The main aim of these procedures is to limit the amount of food intake, induce a sense of fullness with smaller portions, and alter the hormonal responses to food.

Is Bariatric Surgery Covered by Health Insurance?

Yes, bariatric surgery coverage is a recently added coverage in the health insurance. In October 2019, the Insurance Regulatory and Development Authority of India (IRDAI) mandated the inclusion of bariatric or weight loss surgery within health insurance coverage. This directive aimed to provide essential medical care to individuals with obesity and related medical conditions. By incorporating bariatric surgery into family health insurance plans, individual health plans, and even critical illness insurance policies, it was projected that approximately 38% of the rural Indian population and 30% of the urban Indian population would gain access to potentially life-saving treatment.

Why Do You Need Bariatric Surgery Cover?

The cost of bariatric surgery can be hefty, it can be between Rs 2.5 Lakh to Rs 5 Lakh. However, the actual cost of bariatric surgery depends on factors like type of surgery, hospital cost, gastroenterology surgeon’s fees and much more. Having health insurance for bariatric surgery can reduce the financial burden and encourage you to make decisions that will improve your overall health and well-being.

What Bariatric Surgery Cures?

Bariatric surgery resolves many health issues related to obesity. Some of the problems that bariatric surgery can cure are:

• Fatty liver disease
• Gastroesophageal reflux disease
• Arthritis
• High blood pressure
• Breathing disorders
• Urinary stress incontinence
• Cholesterol
• Asthma
• Sleep apnea
• Venous stasis

What are the Criteria for Bariatric Surgery Covered by Insurance?

There are several criteria that insurance companies have that patients must meet to be eligible for bariatric surgery coverage. These criteria include:

• Body Mass Index (BMI)- Patients with a BMI above 40 or 35 with obesity-related health conditions may qualify.
• Documentation of Weight Loss Efforts- The insurance companies require some details and documents of your previous attempts to lose weight through medically supervised programs.
• Medical Necessity- The doctor’s assessment of the health condition and potential benefits of the surgery are also a few important criteria to get covered.

How to Determine the Coverage?

Be Prepared with the Documentation

There are a few steps that need to be followed to get approval for insurance for bariatric surgery, such as medical assessment, document submission, and attending sessions. Be prepared to navigate through these documentation processes to increase the chances of approval.

• Identity proof
• Doctor’s prescription
• Bills of surgical procedures
• Any other documents as requested by the insurer

What is the Waiting Period for Bariatric Surgery?

The waiting period for bariatric surgery depends on policy to policy. However, the waiting period for health insurance for bariatric surgery is mostly 2 to 3 years. So, if you want to go for weight loss surgery, then you need to wait for a few days before availing the benefits.

Types of Bariatric Surgery Procedures Covered in Health Insurance

Health insurance covers the following bariatric surgery procedures:

• Open or laparoscopic gastric bypass
• Sleeve gastrectomy
• Biliopancreatic diversion
• Laparoscopic adjustable gastric banding
• Roux-en-Y gastric bypass

Documenting Weight Loss Efforts

Most of the time companies require evidence of your previous attempts at weight loss through supervised programs. Keep track of these programs in which you have participated for your reference. Following is the list:

• Medical reports include a history of obesity-induced problems.
• Any evidence of undergoing dietary and lifestyle changes for weight loss.
• Proofs of any unsuccessful attempts at weight loss while undergoing pharmacological therapy.

Exclusions of Bariatric Surgery in Health Insurance

Some of the usual exclusions for bariatric surgeries under health insurance are:

  You cannot raise the claim during the initial waiting period of the plan.

  In pre-existing conditions, bariatric surgery does not get covered.

  If you are going through this surgery due to any cosmetic or aesthetic reason, then it will not be covered.

  If the weight gain is a byproduct of medication or poor mental health, the surgery for the same may not be covered.

Conclusion

We need to understand that bariatric surgery can be life-changing for anyone, but at the same time, it can be costly too. Navigating bariatric surgery coverage can be complex. But understanding your policy and meeting the criteria are some of the important ways by which you can make informed choices related to your bariatric surgery and weight loss journey.

If you want to know more about health insurance for bariatric surgery, call our experts at PolicyX.com. We will give you Only Expert Insurance Advice, No Spam & No Gimmicks.