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What Role Does Medical Insurance Play with Coverage for Bariatric Surgery?


According to the World Health Organization, obesity is an escalating global epidemic. People around the world are suffering from obesity primarily due to sedentary lifestyles, unhealthy eating habits, and reliance on processed foods. In addition, many studies have found obesity to be at the root of various other ailments like cardiovascular problems, etc. 

Usually, medical professionals and dietitians recommend dieting and regular exercise to fight obesity. However, in some cases, these weight-loss measures are not enough, and the individual needs a surgical intervention to lose weight. This is called Bariatric Surgery. 

Since obesity is not classified as a disease, many policyholders are not sure if their medical insurance policy covers the cost of a Bariatric Surgery. In this article, we will talk about the role played by health insurance in offering coverage for Bariatric Surgery.

Understanding Bariatric Surgery

Bariatric Surgery is a set of medical procedures where a doctor surgically makes changes to your digestive system to help you lose weight. This is typically recommended for people who are unable to exercise and control their food intake. 

The medical recommendation for this surgery is given to people who have a Body Mass Index (BMI) of 40 or more. It is also recommended for people with a BMI of 35 or more who also have life-threatening ailments like Type 2 diabetes, heart disease, sleep apnoea, etc. Some people opt for Bariatric Surgery for cosmetic reasons too.

Medical Insurance and Bariatric Surgery

Bariatric Surgery usually costs around Rs.3-5 lakhs. While the exact cost depends upon the condition of the person undergoing surgery, the costs associated with the facility and doctors can be steep. Therefore, in 2019, the Insurance Regulatory and Development Authority of India (IRDAI) instructed insurers to include Bariatric Surgery under health insurance plans. 

If you wonder, does health insurance cover bariatric surgery? Here is the answer to your query. Typically, a health insurance company will honour claims that are made for treatments costs as per the terms specified on the policy document. Insurers offering the best health insurance plan in India specify the terms under which the company will reimburse the costs associated with the surgery. Some such terms are:

  • The BMI of the policyholder should be 40 or more or 35+ and have a co-morbidity condition like diabetes, obesity-linked cardiomyopathy, severe sleep apnoea, etc.
  • Non-invasive weight-loss methods cannot be followed due to the medical condition of the policyholder.
  • The doctor has recommended the surgery.

It is important to remember that the coverage offered by the insurer for Bariatric Surgery will be subject to the general terms and conditions of the insurance policy. Also, if you opt for this surgery for cosmetic reasons, then the insurer can reject your claim. Many insurers like Tata AIG also offer health insurance premium calculators in India to calculate the cost of the policy. 

Bariatric Surgery can be a life-saving procedure for people who are unable to work out or go on a diet plan to lose weight. However, if the doctor recommends this surgery, then delaying it is not advisable. Also, the cost of the surgery can create an unplanned burden on you. Hence, look for health insurance plans that cover bariatric surgery and pre and post-hospitalisation costs.

Now that you have the answer to your question, is bariatric surgery covered by insurance? Then, you can consider looking for a policy that covers this surgery. 

Summing Up

Millions of people suffer from obesity in India. While most of them try to follow a strict diet and an exercise regimen, some develop health problems because of it. This is when doctors recommend a Bariatric Surgery option. However, with rising costs of hospitalisation and general medical care, such surgery can derail your savings and investment plans. 

With the right health insurance policy, you can be assured of managing the financial aspect of the surgery without denting your finances and focusing on getting in shape. Make sure that you go through the policy document and talk to your insurer about the coverage offered for this surgery before getting it done. Also, you can use the health insurance calculator to know the health insurance premiums of the policy that you wish to buy. Good Luck!