Health Insurance Benefits for Bariatric Surgery

People around the world are battling obesity. Unhealthy eating habits, dependence on processed food, and sedentary lifestyles have made obesity an escalating global pandemic. The problem with obesity is that it is at the root of various other health-related ailments. The simplest way to fight obesity is by controlling your diet and exercising regularly. 

However, there are many people who need surgical intervention to lose weight because for them the regular weight-loss measures are not enough. Such medical procedures that help people lose weight are clubbed under the category of bariatric surgery.

When you buy a health insurance policy, the insurer makes it clear that the coverage is offered for various diseases and ailments. But, is obesity a disease? Medically, yes. However, it might not be under the list of covered diseases. Then, will the insurance policy offer coverage? In this article, we will talk about bariatric surgery insurance and how it can benefit people opting for this procedure.

But first, let us talk a little bit about the bariatric surgery procedure.

What is Bariatric Surgery?

Bariatric surgery is the name given to a set of procedures that allow doctors to surgically alter your digestive system to help you lose weight. While the common methods are reducing food intake and exercising, many people are unable to do either. In such cases, doctors recommend bariatric weight loss surgery.

Typically, doctors recommend bariatric weight loss surgery to people with a Body Mass Index (BMI) of 40 or more. It can also be recommended to people with a BMI of 35+ if they have other critical conditions like heart disease, diabetes, etc.

A small percentage of people opt for a Bariatric Surgery for cosmetic reasons too.

Bariatric Surgery Insurance

The average cost of bariatric surgery is between three and five lakhs. The actual cost will depend on the condition of the patient, the city, the surgeon, and hospital costs, among other factors. Earlier, insurers did not offer coverage for this surgery. However, in 2019, the IRDAI mandated all health insurers to include it under standard health plans.

Standard health insurance covers bariatric surgery. However, the insurer will define terms under which claims for this surgery will be honoured. Typically, the terms include:

  • The surgery needs to be recommended by a doctor. The insurance policy does not cover bariatric surgery done for cosmetic reasons.
  • A doctor needs to certify that due to the condition of the patient, non-invasive methods of losing weight cannot be followed.
  • The BMI of the policyholder should be more than 35 if he/she has co-morbidity conditions or 40 otherwise.

The coverage for this surgery will also be subject to the other terms and conditions of the policy. People who are suffering from obesity and are unable to cut their diets or exercise to lose weight can face a lot of issues. Bariatric surgery can be a life-saving option for such people. Once the doctor recommends it, you must get it done immediately. 

The total cost of the surgery, including the pre and post-hospitalization costs, can put a burden on your finances. Therefore, make sure that you have a health insurance policy with adequate cover for bariatric surgery.

Summing Up

Obesity is becoming a big problem in India. While people are getting increasingly aware of the problems posed by long-term obesity and are adopting healthy eating and living habits, for some people, surgery is the only choice. If your family has a history of obesity, then it would be prudent to get a health insurance policy that includes bariatric surgery at favourable terms. Among the range of benefits of health insurance, coverage for this surgery is a boon for people struggling with weight loss. If you already have a medical insurance plan, then talk to your insurer about the scope and extent of the cover before getting the surgery done.