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Health Insurance That Covers Bariatric Surgery

What is Bariatric Surgery?

Health Insurance Cover Bariatric Surgery

Does Health Insurance Cover Bariatric Surgery?

Yes, bariatric surgery is now covered by health insurance, provided you meet the standard criteria. According to the 2019 Insurance Regulatory and Development Authority of India, most health insurance companies cover bariatric surgery.

To guarantee coverage, reviewing the terms and conditions of the insurance that covers bariatric surgery is advisable. Bariatric surgery is only covered by health insurance policies if a patient satisfies specific requirements.

Criteria for Availing Coverage for Bariatric Surgery Under Health Insurance

Why Having Health Insurance for Bariatric Surgery is Important?

Obesity has become a significant global health concern, leading to an increased prevalence of various chronic diseases. Excess body fat is strongly associated with heightened risks of conditions such as type 2 diabetes, heart disease, certain cancers, and stroke.

Given such serious health conditions, here is why having health insurance for bariatric surgery is important:

Financial Accessibility

Bariatric surgery can be expensive, with costs often exceeding lakhs of rupees. Health insurance coverage makes these life-changing procedures financially accessible to a broader population.

Encourages Preventive Health Measures

Insurance coverage for bariatric surgery promotes proactive health management, enabling individuals to address obesity before it leads to more severe health issues.

Long-Term Healthcare Savings

While the initial cost of bariatric surgery is significant, it often leads to reduced long-term healthcare expenses by mitigating obesity-related conditions.

Types of Bariatric Surgery Covered in Health Insurance

Bariatric surgery, commonly referred to as weight loss surgery, encompasses various types that are designed to help individuals struggling with obesity achieve weight loss. Health insurance companies offer coverage for such specific types of bariatric surgeries, which include:

Type of Surgery

Description

Roux-en-Y Gastric Bypass

It involves creating a small pouch from the stomach and connecting it directly to the small intestine, which reduces food intake and nutrient absorption.

Biliopancreatic Diversion with Duodenal Switch

This more complex procedure removes a large portion of the stomach and reroutes the intestines, significantly limiting both food intake and nutrient absorption.

Sleeve Gastrectomy

This involves removing a portion of the stomach, resulting in a tube-like structure that limits food intake and decreases hunger hormones.

Laparoscopic Gastric Banding

It entails placing an adjustable band around the upper part of the stomach to create a small pouch. The band can be tightened or loosened over time to control food intake.

Vertical Banded Gastroplasty

This procedure involves partitioning the stomach into two sections using staples and a band, limiting food intake.

Note: Insurance coverage for these procedures varies from policy to policy. Read your policy document before purchasing a health insurance policy to confirm coverage for Bariatric surgery. 

Exclusions Under Health Insurance That Covers Bariatric Surgery

While many health insurance plans now cover bariatric surgery, there are several exclusions and limitations that policyholders should be aware of. Here are some common exclusions:

Claims Made During the Waiting Period

Claims cannot be made during a plan's initial waiting period, which may last about 30 days. If obesity or related conditions are classified as pre-existing diseases, the policy might impose a waiting period of 1-3 years before covering the surgery.

Cosmetic or Non-Medically Necessary Surgery

If the surgery is performed purely for aesthetic reasons and not due to medical necessity (e.g., no severe obesity-related health risks), it is usually not covered by a health insurance plan.

Weight Gain Due to Medication or Mental Health Conditions

Certain drugs and conditions like binge eating disorder, severe depression, or anxiety-related overeating may contribute to obesity. In such cases, some insurers might not cover bariatric surgery.

What is the Cost of Bariatric Surgery in India?

Does Bariatric Surgery Insurance Have a Waiting Period?

Who Should Get Health Insurance That Covers Bariatric Surgery?

Bariatric surgery is not for everyone struggling with weight issues; it is a medical intervention designed for individuals with severe obesity who have been unable to achieve sustainable weight loss through diet, exercise or other medical treatments.

Here are the key criteria for individuals who may need bariatric surgery:

People with a High BMI

A BMI of 40 or higher indicates severe obesity and makes a person an ideal candidate. Surgery may be recommended if the individual also suffers from conditions like diabetes, hypertension, or sleep apnea.

Individuals with Obesity-Related Health Conditions

Bariatric surgery can help manage and even reverse several life-threatening conditions, including Type 2 Diabetes, Heart Disease & Hypertension, Sleep Apnea, etc.

People Who Failed Other Weight Loss Methods

Candidates for bariatric surgery must have attempted and failed weight loss programmes, diet and exercise regimens, medications, etc.

What are the Risks of Delaying Bariatric Surgery?

FAQs About Health Insurance That Covers Bariatric Surgery