22 Nov Good News! Now Health Insurance that Cover Bariatric Surgery
Good News for you if you are planning to go for Weight loss surgery and want to know about insurance coverage for bariatric surgery. As per new guidelines issued by the IRDAI’s (Insurance Regulatory and Development Authority of India) in October 2019, Weight loss surgery is included under medical insurance cover. This positive move by IRDAI in favor of bariatric surgery will now enable people who are fighting with obesity and its complications to avail treatment and remain healthy. Let’s understand some important details regarding the whole procedure.
What is Bariatric Surgery?
Bariatric surgery is a procedure performed on morbid obese individual who are unable to lose weight through other less invasive methods like exercising and diet etc. These procedures are also done for individual who are suffering from class II Obesity along with associated comorbidities. Weight loss surgery not only helps in long term and effective weight loss but is shown to be very effective in treatment of obesity related health issues like diabetes, sleep apnea, dyslipidemia etc. Bariatric Surgery includes a range of procedures from simple restrictive to combined restrictive and malabsorptive.
Weight loss procedure is decided in consultation with the patient and the immediate family members post thorough assessment of various factors including patient age, BMI, food habits, social habits, dietary pattern, co-morbidity status and patient compliance. A thorough psychological evaluation of the patient is also required to check the compliance post-surgery. Bariatric procedures are done laparoscopically which makes them painless, minimally invasive, stitch less procedure with the patient discharged after 3 to 4 days stay in the hospital.
In addition to weight loss, bariatric surgery results in resolution of medical problems like type 2 diabetes, hypertension, obstructive sleep apnea, hyperlipidemias, fatty liver disease, gastroesophageal reflux disease, urinary incontinence, venous stasis, menstrual irregularities, infertility in significant number of patients.
Some of the bariatric procedures helps in weight loss due to diet restriction, some causes weight loss due to both diet restriction and malabsorption of the nutrients. Every procedure requires a lifelong commitment of life style and eating habits modifications for leading a healthy life post Weight Loss Surgery.
How much does Bariatric Surgery Cost?
Patient suffering from morbid obesity fails to undergo bariatric surgery either due to the fear of surgery or lack of finance. With new advances in technology now these surgeries are safer. In recent decade , India has become one of the most sort out destination for the bariatric surgery both for cost factor and quality of care provided.
There are many types of bariatric procedures available. The cost of the surgery depends many factors including but not limited to the type of the procedure recommended by the surgeon, type of hospital and the health status (BMI & associated co morbidities) of the patient. The cost of bariatric surgery in India can ranges from Rs. 2,25,000 to Rs.5,00,000.
Does Health Insurance Cover Bariatric Surgery?
Yes, Now health insurance cover bariatric surgery expense with the condition that it is medically indicated and not done for cosmetic purpose. As per the circular issued by the IRDAI, the insurance policy contracts may allow for expenses related to the surgical treatment of obesity that does met the below conditions:
- Surgery conducted is upon the advice of a Doctor (where the patient has failed to lose weight using less invasive methods of weight loss)
- The surgery/procedure conducted under standard clinical protocols
- Age limit is 18 years of age or older
- Body Mass Index (BMI) should be greater than or equal to 40 or greater than or equal to 35 with severe co-morbidities mentioned
- Obesity-related cardiomyopathy
- Coronary heart disease
- Severe Sleep Apnea
- Uncontrolled Type2 Diabetes
Source: https://www.irdai.gov.in/ADMINCMS/cms/Search_Results.aspx (Chapter III, point “F”)
What to Claim for Bariatric Surgery?
If you are planning for a cashless claim for your Weight Loss Surgery, the first step is to submit documents for pre authorization to your insurance provider. For filing a claim for bariatric surgery, one needs to comply with the terms and conditions of the insurance policy. The claim need to be submitted with the following documents
- Prescription from a surgeon advising Weight Loss Surgery and other supporting diagnostic tests and along with the authorization
- Minimum BMI required for approval of claim is 40 or higher
- Patient with BMI above 35 with associated health problems like sleep apnea, Type 2 Diabetes and heart-related problems.
Is there any locking or waiting period in health insurance for Bariatric Surgery?
The waiting or locking period for Weight Loss Surgery may range from 2 to 4 years. You can apply for claim only after the completion of the said waiting period. Kindly check with your provider before buying the policy for Weight Loss Surgery.
What happens to your Bariatric Surgery benefit if you are porting your health insurer?
A fresh waiting period will be applied for your bariatric surgery benefits if you are porting your health insurance provider.
Medical insurance can cover the following surgical procedures:
- Biliopancreatic diversion
- Open or laparoscopic Gastric bypass
- Sleeve Gastrectomy
- Laparoscopic adjustable gastric banding
- The Roux-en-Y Gastric Bypass
Are there any exclusion for Bariatric Surgery Insurance?
Depending on the kind of insurance you have taken, following exclusions apply to Bariatric procedures:
- You have filed a claim before the completion of you locking period or within 30 days of policy commencement.
- Claims related to pre-existing conditions are also not covered
- Cosmetic/aesthetic reasons
- Obesity due to psychiatric and eating disorder, obesity due to certain drugs and untreated hormonal imbalance.
Conclusion:
One needs to do proper research before finalizing the insurance provider and type of policy to get proper benefit for bariatric or weight loss surgery. Also, instead of relying on verbal communication of the agent, ask for the written policy terms and conditions to fully understand your policy.
