Is Bariatric Surgery Covered Under Health Insurance? Find Out!

In India, obesity has become common among people of all age groups. Lifestyle changes such as eating junk food and consuming alcohol without doing any workouts are the major causes of obesity. It is a condition in which excess body fat may increase the chance of having some critical illnesses. Therefore, it is important to control weight at the right time by undergoing various weight-loss techniques, such as bariatric surgery. Read on to know about bariatric surgery in detail and if it is covered under health insurance. 

What Is Bariatric Surgery? 

Bariatric surgery refers to an operation which an overweight person undergoes to control body fat. The process changes the working of the digestive system to implement weight loss in the body. Generally, individuals consider bariatric surgery as the last weight loss method when none of the methods like dieting or exercising is showing results. While undergoing the surgery, the doctors may suggest you limit the intake of nutrients for effective results. 

What Is The Cost of Bariatric Surgery? 

Generally, the cost of bariatric surgery treatment is between Rs. 2.5 lakh to Rs. 5 lakh. However, the actual cost may depend on various parameters such as surgery, hospital, surgeon’s fee, gastroenterology, and much more. In addition to this, you may need to visit the physician regularly to adapt to a new lifestyle after the surgical procedure. Thus, you may have to pay additional fees for appointment sessions. 

With bariatric medical surgery, an individual can treat various medical conditions including arthritis, high blood pressure,  breathing disorders, asthma, cholesterol, and many others. 

Does Health Insurance Cover Bariatric Surgery? 

According to the guidelines issued by the Insurance Regulatory and Development Authority of India in 2019, health insurance companies can cover bariatric surgery in their insurance policies. The coverage may depend on the type of health insurance plan that you have chosen. In India, coverage for morbid obesity and co-morbidities is provided under health insurance plans. Whenever you claim your insurance for the bariatric procedure, you need to present a valid statement issued by the physician stating that the surgery is necessary. 

Eligibility Criteria For Bariatric Surgery 

You can avail of the coverage for bariatric surgery only if you meet the conditions listed below. 

• A person who is undergoing surgery should be above 18 years of age. 
• Body Mass Index (BMI) score should be 40 or above. 
• If your BMI is 35 and has medical conditions such as diabetes, heart disease, or stroke. 
• You must have the prescription of the doctor and relevant medical reports.

What Is Not Covered Under Bariatric Surgery Health Insurance?

Listed below are some of the things that are not covered under bariatric surgery health insurance. 

• No claims can be issued during the grace period of the policy which is generally 30 days. 
• Claims relating to pre-existing diseases are not covered. 
• No coverage is provided if a person is undergoing surgery for cosmetic and aesthetic reasons. 
• Weight gain happened due to medication side effects or stress that was not covered. 

What Are The Procedures Covered Under Bariatric Surgery Insurance?

Here’s a list of some procedures that are covered under bariatric surgery. 

• Gastric Bypass 
• The Roux-en-Y Gastric Bypass
• Biliopancreatic Diversion with or without Duodenal Switch Gastric Pass 
• Sleeve Gastrectomy 
• Laparoscopic Gastric Banding 

What Documents Are Required to Claim Bariatric Surgery Insurance?

You should have the following documents to raise a claim for bariatric surgery: 

• Medical reports highlighting the history of obesity-related problems. 
• Proof of undergoing dietary and lifestyle changes for weight loss. 
• Evidence of weight loss attempts that failed while receiving pharmaceutical treatment (if applicable).

Conclusion 

Usually, bariatric surgery is not covered by a standalone health insurance plan. However, you can buy this add-on cover at a low premium by paying an additional premium to the insurance companies. The cost of bariatric surgery is high as advanced medical knowledge and equipment are implemented during the procedure. Thus, a health insurance policy with bariatric surgery coverage will cover all your expenses incurred during the treatment.

Also Read: What Is Coinsurance In Health Insurance?