What is Health Insurance for Bariatric Surgery?

Being overweight or obese is not just a lifestyle concern but a serious health issue that could lead to diabetes and heart disease, along with impacting your mental health. Bariatric surgery has emerged as a life-saving solution for people suffering from severe obesity who are not able to lose weight through traditional methods. As per the guidelines of the Insurance Regulatory and Development Authority (IRDAI) released in October 2019, bariatric surgeries, commonly referred to as weight loss surgeries, are to be included in health insurance plans, making them more accessible and affordable to people.

However, bariatric surgery is allowed to be included in the insurance under certain circumstances. In this guide, we will explore everything that you need to know about insurance that covers bariatric surgery, from eligibility criteria to the claim process.

Understanding Bariatric Surgery and Its Importance

Bariatric surgery is a viable option for individuals who are unable to lose weight through a low-calorie diet and exercise. This surgery is most effective for treating a person with class III obesity. The patients are strongly advised to follow a certain diet plan before undergoing bariatric surgery, followed by exercise, to avoid any weight gain after the surgery is completed.

Pre-requisite for Undergoing Bariatric Surgery

Your doctor may recommend undergoing bariatric surgery if you are diagnosed with class III obesity and under 3 pre-requisite:

• The minimum age required to be eligible for bariatric surgery is 18 years.
• Your body mass index (BMI) is either equivalent to or more than 40. 
• Bariatric surgery can be performed in case your BMI is 35 or more or if you are suffering from other serious health conditions such as hypertension, fatty liver, and various cardiovascular diseases.

Is Bariatric Surgery Covered by Insurance?

There are various insurance that cover bariatric surgery if you meet the requirements in the policy, such as morbid obesity or any life-threatening conditions. However, the bariatric surgery coverage could only be claimed with proof to the insurance provider that the surgery is medically essential and is not being used for any cosmetic purposes.

Procedures Covered Under Bariatric Surgery 

Health insurance coverage for bariatric surgery allows compensation for various types of procedures performed during the surgery, such as:

• Biliopancreatic diversion
• Open or laparoscopic gastric bypass
• Sleeve gastrectomy
• Laparoscopic adjustable gastric banding
• Roux-en-Y gastric bypass

How to Check if Your Health Insurance Offers Bariatric Surgery Coverage?

You can follow these steps to check if your insurance covers bariatric surgery:

Step 1: Read the Policy Documents

Go through your insurance policy documents and look for the section that covers the surgery's inclusions and exclusions. Check the clauses for co-payments, deductibles, or any other additional costs.

Step 2: Contact your agent

Contact the agent or customer care helpline of the insurance provider for details on insurance that covers bariatric surgery.

How to Claim Insurance for Bariatric Surgery?

Claiming your health insurance to cover bariatric surgery requires careful planning and submission of documents that meet the insurer’s guidelines. Here is the step-by-step breakdown of the claim process:

• Review your policy documents for coverage for bariatric surgery. Confirm the waiting period, exclusion, and pre-conditions mentioned in the clauses. If you are unsure, contact the customer care helpline.
• Get a written confirmation from a certified doctor that the surgery is necessary, along with supported documents like BMI records, medical reports, and previous attempts at weight loss.
• Choose a hospital from your insurer’s network of hospitals for cashless claims. Prepare for reimbursement claims If you are opting for a non-network hospital.
• For cashless claims, get pre-authorisation approval from the insurer through the hospital. Once approved, your insurer will settle the payment with the hospital.
• In the case of a non-network hospital, pay the surgery costs, keep all the medical reports, bills, and receipts, and submit a reimbursement claim form with your insurer along with all the required documents. 
• Follow up regularly with your insurer and track your claim request. The claim will generally be processed within the insurer's turnaround time (TAT).

Take Control of Your Health with the Right Insurance

Are you struggling with a health-related illness such as obesity? Surgery or the proper medical procedures can be life-changing and vastly improve your health. However, the high cost of the procedures often becomes a significant barrier in people's lives, restricting them from availing themselves of the opportunity. The good news is that you choose the right health insurance plans from prominent insurance providers in India, such as Niva Bupa, at affordable prices and get yourself covered in case of any medical emergencies like bariatric surgery coverage.

Our comprehensive health insurance plans include surgery costs, diagnostic tests, medication charges, doctor consultations, and ambulance charges, making it the right choice for you and your family. So, secure your health now; contact our agent today or visit the website for more details.

Frequently Asked Questions (FAQs)

1. Is bariatric surgery covered by insurance plans in India?

   Yes, various health insurance plans cover bariatric surgery that is deemed medically essential and is not being performed for cosmetic purposes. 

2. What are things to consider before undergoing bariatric surgery?

   Review your policy documents, consult a specialist doctor, collect required documents, and get pre-authorisation before undergoing bariatric surgery.

3. Is there any waiting period to claim insurance for bariatric surgery?

   Yes, there is a waiting period that ranges from 2-3 years for bariatric surgery. You can put in a claim for your surgical costs after the completion of the waiting period post-policy purchase.