Check Health Insurance For Bariatric Surgery - Importance & Coverage

Bariatric surgery is a surgery that supports weight reduction in overweight patients. This is a kind of weight loss surgery that alters the digestive system of the body to enable a patient to keep their shape. The operation is recommended for patients with a Body Mass Index (BMI) of 40 or higher, or with a BMI of 35 or higher in cases where comorbidities exist; these include obesity-related type 2 diabetes, hypertension, and sleep apnea.

Read on to know about the importance of bariatric surgery, types and eligibility for the same, reasons to consider health insurance for the surgery, and the best health insurance.

Importance of Bariatric Surgery

Bariatric Surgery has come with a bundle of benefits in our life. It reduces weight, helps to get rid of severe chronic diseases, and provides quality of life. Let's have a look -

1. Weight Loss and Maintenance

Bariatric surgical procedures allow individuals with a BMI ≥ 35 to effectively and safely lose weight. Indeed, research has confirmed that 90% of patients who undergo this surgery are able to maintain at least 50% or more of weight loss over the long term. [1]

2. Improve Comorbidities

The surgery improves comorbidities linked with obesity, such as type 2 diabetes, hypertension, sleep apnea, etc. It helps reduce the risk of mortality due to diabetes by 92% and due to heart disease by 40%. [2]

3. Enhanced Quality of Life

It tends to improve the quality of life post-surgery. Many claim that it promotes mobility, reduces anxiety, and boosts self-esteem.

4. Financial Help

The cost of the surgery is effective in the long run. It helps in eradicating unwanted diseases related to obesity and therefore the financial burden which comes with diseases.

Why Consider Health Insurance for Bariatric Surgery?

Health insurance provides several benefits for Bariatric Surgery. It reduces the cost-effectiveness and quality of life provided to the obese policyholders. Let's see the effectiveness of health insurance- 

1. Financial Protection

As per guidelines from IRDAI in 2019, a lot of health insurance plans cover bariatric surgery with certain criteria. Insurance gives you protection from the extremely high costs of surgery. This surgery could cost anything between ₹2.5 lakhs and ₹6 lakhs in India, but health insurance considerably releases the financial burden and makes the procedure more accessible.

2. Health Benefits

Bariatric surgery is a life-saving intervention to those people suffering from conditions associated with obesity, such as type 2 diabetes, hypertension, and sleep apnea. It thus enables necessary treatments to be provided in a timely manner and helps avoid serious health problems

3. Improved Quality of Life

Insurance coverage helps improve one's quality of life by reducing health problems associated with obesity. It ensures that the patient receives necessary care without a financial burden.

Eligibility Criteria of Health Insurance For Bariatric Surgery

• Patients who are between 18-70 years old. 
• Patients must have a BMI over 40 or a BMI over 35 with associated health conditions like type 2 diabetes, hypertension, or sleep apnea.
• Documentation of specific pre-surgery requirements, like medically supervised weight-loss attempts lasting three to six months and a doctor's recommendation. 
• Patients must have no such medical conditions as untreated infections, active cancer, or severe psychological conditions.
• Patients are required to commit to lifestyle changes like quitting smoking and following dietary guidelines before and after surgery. 
• Patients need to quit smoking at least six weeks before the surgery. 

Types of Bariatric Surgery Covered Under Health Insurance

Many health insurance policies cover various types of bariatric surgery as per the guidelines issued by IRDAI in 2019. Following are the main types of bariatric surgery generally covered under health insurance policies:

1. Laparoscopic Roux-en-Y Gastric Bypass: 

This is one of the most prevalent and common bariatric surgeries. This involved the creation of a small pouch in the stomach leading food directly to the small intestine with minimum dispersion of nutrients and also reduced food intake.

2. Laparoscopic Sleeve Gastrectomy: 

It decreases the size of the stomach by removing a large portion of it. It reduced food intake and appetite

3. Laparoscopic Adjustable Gastric Banding: 

During this procedure, an adjustable band is placed across the top portion of the stomach. This results in the creation of a small pouch and less food intake.

4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS): 

The surgery involves sleeve gastrectomy and bypassing most of the portion of the small intestine. It significantly reduces caloric intake and absorption.

5. Mini Gastric Bypass: 

It is a variation of the gastric bypass. This procedure has the dual effect of reducing the size of the stomach and limiting nutrient absorption.

Health Insurance Companies and Policies For Bariatric Surgery

In India, most health insurance companies cover bariatric surgery based on the guidelines from IRDAI in 2019. Following are the major insurance companies that provide covers for Bariatric Surgery policies:

1. Tata AIG Health Insurance

Tata AIG Health Insurance covers bariatric surgery in India, given certain conditions and doctor recommendations. The health insurer covers the treatment-related procedures such as laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy. It provides comprehensive coverage for most of the medical needs with 7000+ cashless hospital networks.

2. Star Health Insurance

Star also covers bariatric surgery under certain conditions. The coverage is up to Rs. 2,50,000/- and Rs. 5,00,000/ respectively for the entire cycle of bariatric surgery, pre and post-hospitalization expenses.

3. Bajaj Allianz Health Insurance

Bajaj Allianz offers coverages for bariatric surgery in case of medical needs only. They don't cover cosmetic needs. Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy and biliopancreatic diversion with duodenal switch are generally allowed.

Factors to Consider While Buying Health Insurance for Bariatric Surgery

While choosing a company's insurance policy for bariatric surgery, you must check for several factors to get excellent and hassle-free coverage. Let's discuss the factors first-

1. Coverage

While choosing the policy, see its policy for surgery coverage. Most of the following procedures, like gastric bypass, sleeve gastrectomy, laparoscopic adjustable gastric banding, are covered under this policy. However, some policies confine their specific procedures to pre-operative evaluations, consultation, nutritional counselling, and post operative care. 

2. Eligibility Criteria

Most of the policies have different eligibility criteria, so you need to check all the eligibility criteria before choosing any of them. Commonly, these would be: age between 18 and 70 with no significant allergies, heart diseases, or psychological problems; a BMI of 40 or above, or 35 with comorbidities related to obesity; etc.

3. Cost of Premiums

Premium cost is another crucial factor to consider while choosing company insurance. Bariatric surgery is generally an expensive treatment; therefore, one needs to check the premium cost, deductible, limitation, and any cap on specific procedures. 

4. Insurer Reputation

Reputation also plays a very important role. To get better service, you must go through the reviews of the policyholders and their customer care review. 

5. Documentation Process

Always check the documentation process of the insurance policy. Complex documentation can make it very difficult to access the surgery procedures and create additional hardships. 

Customer Support

Insurance companies provide good customer support to access the benefits of bariatric surgery. They are professional and cordial in attitude and know the complexity of the high-value claims.

You can also contact the nearest relationship manager at Insurance Dekho through email at support@insurancedekho.com or by calling at +91-755 1196 989. 

Conclusion

Bariatric surgery is necessary to reduce comorbidities related to obesity and also to maintain a good quality life. Since the operation is costly, Insurance becomes a must to cover the surgery procedure. As per the guidelines issued by IRDAI in 2019, bariatric surgery comes under coverage under certain conditions. So, compare several policies to choose an insurance suitable for your needs that gives good coverage.

FAQs

Ques 1. What is the limit applicable for bariatric surgery?

Ans. Bariatric Surgery has a certain amount of weight. This means one's minimum BMI must be at or above 40, which is approximately 100 pounds overweight.

Ques 2. What is the waiting period for bariatric surgery?

Ans. Most Insurance has an initial waiting period of about 30 days for Bariatric Surgery. Pre-existing conditions require 2 to 4 years.

Ques 3. Is bariatric surgery covered under CGHS?

Ans. These are Government hospitals and PSU hospitals that are empanelled under CGHS/CSMA Rules. However, Bariatric Surgery is not allowed in private non-impanelled hospitals under CGHS/CS(MA) Rules.

Ques 4. What are the 30 rules for bariatric surgery?

Ans. There are 30 rules which doctors suggest for post-bariatric surgery to follow weight loss goals. One such rule is to eat and drink slowly: it is suggested to take at least 30 minutes to eat and 30 to 60 minutes to drink 1 cup of liquid to avoid dumping syndrome.

Ques 5. What is the 20 20 20 rule after bariatric surgery?

Ans. The rule 20 20 20 after bariatric surgery: to chew every piece of food 20 times, put cutlery down between the mouthfuls for 20 seconds, and eat the meal in about 20 minutes.