Good News! Insurance cover now available for bariatric surgery in India

India is reeling under an obesity pandemic especially related to diabetes and related comorbidities. The obesity rates have nearly tripled over the past four decades resulting in health risks and fatalities.

Along with comorbidities, obese people are at a higher risk cancer, four times higher risk of suffering from cardiac issues, and nearly ten to twelve times higher risk of suffering from COVID-19 and related fatalities. The most worrying fact is that growing children and adolescents are being adversely affected by the obesity pandemic.

Bariatric surgery has emerged as a time-tried tested solution that alleviates obese people from undergoing immense pain and trauma while offering them yet another valuable opportunity to live a healthier and happier life.

In reality, bariatric surgery is an expensive affair with overall expenses ranging from Rs. 3.5-15 lakhs depending upon the treating bariatric surgeon and the hospital chosen for the same.

Good News! Insurance cover now available for bariatric surgery in India

Dr. Harsh Sheth, one of the best bariatric surgeon in Mumbai shares his opinion on this development, ‘The medical fraternity has put forth a feasible treatment to deal with obesity, and its inclusion in health insurance coverage is a big step forward towards ensuring healthy individuals with fewer insurance claims for subsequent illnesses that can be prevented with weight loss surgery. The entire community of bariatric surgeons is grateful for IRADI for this decision as it will allow bariatric surgery to reach those patients who deserve surgery, but cannot afford to pay out of pocket for surgical treatment.’

Taking a cue from countries such as Europe, Saudi Arabia, Brazil, Australia, America, and so on which cover obesity and its allied disorders under health insurance programmes, the Insurance Regulatory and Development Authority of India (IRDAI) has also agreed to cover obesity and its comorbidities under health insurance programmes effective 1st October 2020.

This decision of offering bariatric surgery cover within health insurance policy highlights the awareness and the concern of the Government of India and the insurance regulatory body to tackle the ongoing obesity epidemic.

Currently, the bariatric procedures covered under health insurance policies are laparoscopic sleeve gastrectomy and gastric bypass (both Roux-en-Y gastric bypass and One anastomosis gastric bypass).

Dr. Harsh Sheth, bariatric surgeon in Mumbai lists the benefits of bariatric surgeries as, ‘These procedures are designed to reduce the ghrelin hunger hormone levels and enhance the sensitivity to insulin. These modifications go a long way in assisting the patient’s firm resolve in limiting weight gain and reducing the incidence of comorbidities.'

Insurance coverage may be granted for morbidly obese patients who meet the following conditions:

- Surgery needs to be backed up by all medical and diagnostic tests

- The treating physician must recommend surgery

- The insured person undergoing surgery must be at least 18 years of age

- BMI >= 40 kg/m2

- BMI >= 35 kg/m2 with at least 2 obesity related co-morbidities such as coronary heart disease, sleep apnoea, uncontrolled type 2 diabetes mellitus, non-alcoholic fatty liver disease etc.

It is essential to provide an in-depth medical history of the issues related to obesity and the multiple unsuccessful attempts towards weight loss through lifestyle modifications and medications in the past six months. This validates the necessity of bariatric surgery on account of medical conditions and ensures that the patient is eligible for health insurance cover.

Insurance companies may charge a slighter higher premium for bariatric insurance cover. The waiting period before the patient can go ahead with bariatric surgery and cover its expenses through a health insurance policy can vary from 0 days to 48 months, depending on the type of insurance policy one holds. It is best to go through your insurance policy guidelines or consult with the insurance agent to make an informed decision.

The move to cover bariatric surgery under health insurance has been long-awaited and people can take advantage of this to ensure they fight obesity in the most scientific manner with the best possible tools.

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Free Press Journal