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Imagine this: you’ve been on countless diets and tried every workout plan, yet your weight remains the same. 😞
In such cases, obesity can lead to serious issues like diabetes, heart disease, and joint pain. Hence, doctors may suggest undergoing bariatric surgery (weight-loss surgery). But here’s the big question: will your health insurance cover it?
The good news is that many insurance providers in India now offer coverage for bariatric surgery, but there are conditions and fine print you need to know. In this article, you will learn what types of bariatric surgery are, why they are important, and when you are eligible for them.
In simple words, weight-loss techniques involving surgery are called Bariatric Surgery. These operations aim to alter the digestive system to help with weight loss. It is a safe process that can assist patients in losing weight and eliminating extra pounds.
While some operations may limit the quantity of nutrients your body can absorb, others may limit the amount of food you consume. These procedures are usually only recommended when diet and exercise have not produced the desired effects.
People who are obese and have major weight-related health problems, such as cardiovascular disease, type-2 diabetes, high blood pressure, etc., are advised to have this operation.
Yes, bariatric surgery is now covered by health insurance, provided you meet the standard criteria. According to the 2019 Insurance Regulatory and Development Authority of India, most health insurance companies cover bariatric surgery.
To guarantee coverage, reviewing the terms and conditions of the insurance that covers bariatric surgery is advisable. Bariatric surgery is only covered by health insurance policies if a patient satisfies specific requirements.
Obesity has become a significant global health concern, leading to an increased prevalence of various chronic diseases. Excess body fat is strongly associated with heightened risks of conditions such as type 2 diabetes, heart disease, certain cancers, and stroke.
Given such serious health conditions, here is why having health insurance for bariatric surgery is important:
Bariatric surgery can be expensive, with costs often exceeding lakhs of rupees. Health insurance coverage makes these life-changing procedures financially accessible to a broader population.
Insurance coverage for bariatric surgery promotes proactive health management, enabling individuals to address obesity before it leads to more severe health issues.
While the initial cost of bariatric surgery is significant, it often leads to reduced long-term healthcare expenses by mitigating obesity-related conditions.
Bariatric surgery, commonly referred to as weight loss surgery, encompasses various types that are designed to help individuals struggling with obesity achieve weight loss. Health insurance companies offer coverage for such specific types of bariatric surgeries, which include:
Type of Surgery |
Description |
Roux-en-Y Gastric Bypass |
It involves creating a small pouch from the stomach and connecting it directly to the small intestine, which reduces food intake and nutrient absorption. |
Biliopancreatic Diversion with Duodenal Switch |
This more complex procedure removes a large portion of the stomach and reroutes the intestines, significantly limiting both food intake and nutrient absorption. |
Sleeve Gastrectomy |
This involves removing a portion of the stomach, resulting in a tube-like structure that limits food intake and decreases hunger hormones. |
Laparoscopic Gastric Banding |
It entails placing an adjustable band around the upper part of the stomach to create a small pouch. The band can be tightened or loosened over time to control food intake. |
Vertical Banded Gastroplasty |
This procedure involves partitioning the stomach into two sections using staples and a band, limiting food intake. |
Note: Insurance coverage for these procedures varies from policy to policy. Read your policy document before purchasing a health insurance policy to confirm coverage for Bariatric surgery.Â
While many health insurance plans now cover bariatric surgery, there are several exclusions and limitations that policyholders should be aware of. Here are some common exclusions:
Claims cannot be made during a plan's initial waiting period, which may last about 30 days. If obesity or related conditions are classified as pre-existing diseases, the policy might impose a waiting period of 1-3 years before covering the surgery.
If the surgery is performed purely for aesthetic reasons and not due to medical necessity (e.g., no severe obesity-related health risks), it is usually not covered by a health insurance plan.
Certain drugs and conditions like binge eating disorder, severe depression, or anxiety-related overeating may contribute to obesity. In such cases, some insurers might not cover bariatric surgery.
Bariatric surgery in India is expected to cost between 1 lakh and 5 lakhs(1). The cost varies depending on several factors, such as:
If someone has a medical problem that could arise before or after the surgery for connected or unrelated reasons, it could increase the cost of the surgery. Therefore, seeking insurance for weight loss surgery is a good idea before dealing with such medical concerns.
Yes, bariatric surgery has a waiting period for health insurance. It is typically 2 years, depending on your insurer and policy terms. During this time, any expenses related to bariatric surgery are not covered.
Additionally, bariatric surgery is usually covered only if it is medically necessary, such as in cases of severe obesity, with related health complications like diabetes or hypertension. It’s important to review your policy details to understand the exact waiting period and eligibility criteria for bariatric surgery coverage.
Bariatric surgery is not for everyone struggling with weight issues; it is a medical intervention designed for individuals with severe obesity who have been unable to achieve sustainable weight loss through diet, exercise or other medical treatments.
Here are the key criteria for individuals who may need bariatric surgery:
A BMI of 40 or higher indicates severe obesity and makes a person an ideal candidate. Surgery may be recommended if the individual also suffers from conditions like diabetes, hypertension, or sleep apnea.
Bariatric surgery can help manage and even reverse several life-threatening conditions, including Type 2 Diabetes, Heart Disease & Hypertension, Sleep Apnea, etc.
Candidates for bariatric surgery must have attempted and failed weight loss programmes, diet and exercise regimens, medications, etc.
The rising health problem of obesity impacts the majority of Indians. The World Health Organisation (WHO) reports that throughout the past forty years, the number of medical cases of obesity has tripled.
If the obese condition is not managed, one may develop other health problems such as:
To Sum Up:
If obesity is not treated promptly, it can be lethal. Although doctors attempt to manage the illness by food and exercise, this may not always work. To lose weight and lead a productive life, you should undergo bariatric surgery. Having a health insurance plan for bariatric surgery becomes essential in these situations.
Remember, bariatric surgery is a life-changing procedure, not just a weight-loss shortcut; hence, having health insurance is the right choice! 🙂
According to IRDAI, bariatric surgery is covered by health insurance; however, you must meet some criteria and eligibility requirements.
According to IRDAI, bariatric surgery is covered by health insurance; however, you must meet some criteria and eligibility requirements.
Here are the requirements to be eligible for bariatric surgery: You must have a BMI of 40 or more and be at least 18 years old. You need to have the results of diagnostic tests and a doctor's prescription stating that surgery is medically essential. You can still obtain coverage if you have comorbid conditions like diabetes, stroke, or hypertension and your BMI is between 35 and 40.
Here are the requirements to be eligible for bariatric surgery:
When purchasing health insurance, you must carefully study the policy document's features and limitations. If unsure, consult the agent or insurance provider if your insurer covers bariatric surgery.
When purchasing health insurance, you must carefully study the policy document's features and limitations. If unsure, consult the agent or insurance provider if your insurer covers bariatric surgery.
Yes, most health insurance plans require a 30-day initial waiting time for bariatric surgery, and if you already have a medical condition, you must wait an additional 1-2 years to obtain coverage.
Yes, most health insurance plans require a 30-day initial waiting time for bariatric surgery, and if you already have a medical condition, you must wait an additional 1-2 years to obtain coverage.
Patients who have been clinically identified as Class III obese may be candidates for bariatric surgery. There are two situations under which your physician will suggest bariatric surgery: You have a body mass index of 40 or more. This amounts to 100 pounds of excess weight. You have one or more severe medical conditions, such as hypertension, fatty liver, and cardiovascular disease, and your body mass index is 35 or higher.
Patients who have been clinically identified as Class III obese may be candidates for bariatric surgery. There are two situations under which your physician will suggest bariatric surgery:
Yes, if you switch to a new plan, you will be covered for bariatric surgery. However, this is only possible if the new plan also provides financial assistance for bariatric surgery. If appropriate, the new plan will impose a new waiting period on you.
Yes, if you switch to a new plan, you will be covered for bariatric surgery. However, this is only possible if the new plan also provides financial assistance for bariatric surgery. If appropriate, the new plan will impose a new waiting period on you.
The base plan of certain health insurance policies may not cover bariatric surgeries. Hence, you must opt for it as a slightly higher-cost add-on. Therefore, before purchasing a plan, it is crucial to confirm this with your insurer.
The base plan of certain health insurance policies may not cover bariatric surgeries. Hence, you must opt for it as a slightly higher-cost add-on. Therefore, before purchasing a plan, it is crucial to confirm this with your insurer.
You could require an amount insured of at least Rs. 5 lakhs because bariatric surgeries might cost anywhere from Rs. 2.5 lakhs to Rs. 5 lakhs. However, you also need to account for the price of any post-surgery assistance you might need, such as dietary counselling from a nutritionist and other fees associated with changing your lifestyle.
You could require an amount insured of at least Rs. 5 lakhs because bariatric surgeries might cost anywhere from Rs. 2.5 lakhs to Rs. 5 lakhs. However, you also need to account for the price of any post-surgery assistance you might need, such as dietary counselling from a nutritionist and other fees associated with changing your lifestyle.
If you are porting an existing policy from some other general or health insurance company or if you are adding this cover while renewing your health policy, a fresh waiting period will be applied for bariatric surgery benefit.
If you are porting an existing policy from some other general or health insurance company or if you are adding this cover while renewing your health policy, a fresh waiting period will be applied for bariatric surgery benefit.
Yes, some plans may exclude certain types of bariatric surgery or have limitations on coverage. For example, some insurers may not cover procedures considered experimental or cosmetic, and some might exclude a certain procedure. Hence, it is always important to read your policy document before purchasing.
Yes, some plans may exclude certain types of bariatric surgery or have limitations on coverage. For example, some insurers may not cover procedures considered experimental or cosmetic, and some might exclude a certain procedure. Hence, it is always important to read your policy document before purchasing.
Yes, Digit covers certain bariatric surgeries if the specific eligibility criteria are met. Digit provides bariatric surgery coverage in all policies up to the sum insured. However, it merely depends on the mutual agreement of the insurer and the insuree.
Yes, Digit covers certain bariatric surgeries if the specific eligibility criteria are met. Digit provides bariatric surgery coverage in all policies up to the sum insured. However, it merely depends on the mutual agreement of the insurer and the insuree.
If your insurance denies coverage, you can appeal the decision. This often involves providing additional documentation from your healthcare provider to demonstrate medical necessity. You may also explore other options like financing plans or grants.
If your insurance denies coverage, you can appeal the decision. This often involves providing additional documentation from your healthcare provider to demonstrate medical necessity. You may also explore other options like financing plans or grants.
Yes, there may be additional costs such as co-pays, deductibles, and coinsurance. Some services related to the surgery, like nutritional counselling or follow-up care, might also incur extra costs.
Yes, there may be additional costs such as co-pays, deductibles, and coinsurance. Some services related to the surgery, like nutritional counselling or follow-up care, might also incur extra costs.
Most insurers require documentation of medical necessity, including a Body Mass Index (BMI), documented obesity-related health conditions and evidence of prior unsuccessful weight loss attempts.
Most insurers require documentation of medical necessity, including a Body Mass Index (BMI), documented obesity-related health conditions and evidence of prior unsuccessful weight loss attempts.
Unfortunately, bariatric surgery is not the most effective method for losing weight; it depends more on lifestyle. The procedure's effectiveness greatly depends on your dedication to making regular lifestyle adjustments, even though it might be a useful tool.
Unfortunately, bariatric surgery is not the most effective method for losing weight; it depends more on lifestyle. The procedure's effectiveness greatly depends on your dedication to making regular lifestyle adjustments, even though it might be a useful tool.
Please try one more time!
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Author: Team Digit
Last updated: 20-05-2025
CIN: L66010PN2016PLC167410, IRDAI Reg. No. 158.
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