The number of diseases directly related to obesity can be quite intimidating. There are enough studies and reports that suggest obesity increases the chances of several cardiovascular issues, diabetes, and some deadly diseases as well. Thus, it is not surprising that a lot of people are now conscious of their health and want to reduce any additional kilos that they might be carrying around.
Once you decide that you need to get on a health loss journey, there are a few options available for you. You can consult a dietician and start a regime of regular workouts to help you with your weight loss. However, in certain cases, these might not be very effective, and you might consider weight loss surgery or bariatric surgery.
If you are wondering whether health insurance plans cover bariatric surgeries, here is all that you need to know about them.
Bariatric Surgery
Before we get into the details of health insurance plans and their coverage related to bariatric surgeries, here is what surgery means. Some people find it difficult to reduce weight even after working out or walking on a regular basis. For such people, bariatric surgery comes to the rescue.
The operation aids in reducing weight and getting rid of the additional weight that one might have. This is especially beneficial for people who are obese and have a higher BMI (body mass index). Apart from merely shedding weight, the surgery can help in avoiding medical issues in the future.
Bariatric surgery is usually recommended for people who have a BMI of 40 or above. Doctors suggest this surgery for people suffering from serious weight-related medical conditions such as Type 2 diabetes, cardiovascular diseases, sleep apnea, etc.
Patients are advised to follow a certain diet prior to the surgery and exercise post the completion of surgery to avoid any weight gain. Though the surgery is safe, there might be some complications such as internal bleeding, blood clots in the lungs and infections.
A doctor must recommend the surgery for it to be covered as a part of a health insurance plan, provided that the plan already covers bariatric surgeries.
Cost of Bariatric Surgery
The total cost of bariatric surgery is one of the reasons for people to look for health insurance plans that cover bariatric surgeries. The surgery can cost anywhere between INR 2.5 lakhs to INR 5 lakhs in India. And the cost depends on a myriad of factors such as the city in which you want to get the surgery done, the hospital, the type of surgery, the surgeon’s fees, etc. There are a few additional expenses as well, such as anaesthesia, follow-up visits, and the cost of surgical equipment.
Here are some of the issues that are related to obesity and that might get resolved after bariatric surgery.
- High Blood Pressure
- Sleep Apnea
- Fatty Liver
- Arthritis
- Cholesterol
- Venous Stasis
Health insurance plans usually cover the following types of surgeries:
- Sleeve Gastrectomy
- Biliopancreatic Diversion
- Laparoscopic Adjustable Gastric Banding
- Laparoscopic Gastric Bypass
- Roux-en-Y Gastric Bypass
Does Your Health Insurance Cover Bariatric Surgeries?
Health insurance plans cover bariatric surgeries if the policyholder meets certain criteria. Coverage for bariatric surgery largely depends on the health insurance that you have opted for. In general, health insurance plans accept claims related to life-threatening conditions, comorbidities, and morbid obesity.
As long as the doctor recommends the surgery, the policy will most likely cover it. You only need to submit proof that the surgery is required and is not for cosmetic purposes.
Until 2019, bariatric surgery was one of the most common exclusions in health insurance plans. However, things have changed in the past couple of years. And now with technical advancements and updated guidelines by IRDAI, a lot more insurance providers offer cover for bariatric surgeries.
Do I Have to Wait for Bariatric Surgery?
The standard waiting period of a health plan applies to bariatric surgeries as well. Depending on the policy that you have picked, the waiting period can be anytime between 2 to 4 years. You must complete a mandatory waiting period before you can opt for cashless health insurance.
Are There any Exclusions?
A family floater health insurance plan or a crucial illness health insurance plan usually has the following exclusions, as far as bariatric surgeries are concerned.
- If the surgery is for cosmetic or aesthetic reasons only.
- If you claim for the surgery within 30 days of commencement of the policy.
- Any pre-existing conditions are not included.
- Obesity due to drugs, eating disorders, psychiatric reasons or hormonal imbalance is not covered.
If you want to claim your health insurance plan for bariatric surgery, it is recommended to do proper research before buying one. Or on your health insurance renewal.
How to Claim Policy for Bariatric Surgery?
As mentioned earlier, you must meet certain criteria to avail yourself of the benefits of bariatric surgery. You must submit the following set of documents as well.
- A patient with a BMI of 40 or higher can apply for the claim.
- The diagnostic tests and recommendations to undergo bariatric surgery must be prescribed by a surgeon.
- A policyholder can still claim for the policy if they have a BMI of 35 or higher or if they face any medical condition such as sleep apnea or type-2 diabetes or heart-related issues.
- You must submit all medical reports and descriptions to file your claim for bariatric surgery.
Conclusion
A base health insurance plan might not be able to provide you with cover for bariatric surgeries. Some insurance providers offer coverage as an add-on to a base plan. By paying a small premium, you can get coverage for bariatric surgery.
Also, it is advisable to do your research before you opt for a health insurance plan or buy the add-on for bariatric surgery. The policy details usually contain details regarding coverage of certain surgeries. However, it shows the maturity of the insurance industry over the last few years, as they adapt to a more customer-friendly approach to coverage and procedures.
Read more - Waiting Period In Health Insurance
