Health Insurance That Covers Bariatric Surgery

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:

• 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.

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 1-3 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:

• 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.

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.

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.

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.

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.

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.