Is Bariatric Surgery Covered by Insurance in India?

Posted on: Dec 16, 2024 | 3 mins | Written by: HDFC ERGO Team

Is Bariatric Surgery Covered by Insurance in India?

Does Health Insurance Cover Bariatric Surgery

Imagine you are passionate about food and love to try out different cuisines. You always make sure that you work out well to shed those calories gained. However, a back injury made you cut down on your visits to the gym for a year, and you didn’t realise that your weight had steadily increased. What happened next was even worse — the increased weight brought along many health issues like high blood pressure, joint pain, and constant fatigue. Your doctor suggested that you get bariatric surgery done. But does your comprehensive health insurance plan cover the costs? Let’s find out.

What is Bariatric Surgery?

Obesity increases the risk of life-threatening illnesses like Type 2 diabetes, stroke, cardiac issues, hypertension, and certain cancers. When people with severe obesity are unable to lose weight with traditional methods like diet, exercise, medication, or other weight loss methods and are at risk of associated illnesses, doctors recommend bariatric surgery. Also known as weight loss surgery, bariatric surgery refers to surgical procedures that help people with obesity lose extra weight. In this procedure, the surgeon makes changes to your digestive system (usually the stomach and sometimes the small intestine) to regulate your food intake or reduce the body’s ability to absorb calories and fat. It can also reduce the hunger signals that travel to your brain from the digestive system.

Types of Bariatric Surgery

The most common forms of bariatric surgery are –

1. Gastric Bypass (Roux-en-Y Gastric Bypass)

The surgeon cuts the top portion of the stomach and seals it off from the rest of the stomach. The small intestine is then divided and a part of it is connected with the smaller portion of the stomach or pouch. The food you eat goes into the pouch, then directly into the small intestine, bypassing most of the stomach. This restricts how much food your stomach can hold and how much nutrition your small intestine can absorb.

2. Gastric Sleeve or Sleeve Gastrectomy

In this procedure, a large portion of your stomach, say about 80%, is removed to limit the amount of food you can consume in one sitting. A small tube-like sleeve is created, which cannot hold as much food. It also reduces the hunger hormones normally produced in your stomach.

3. Adjustable Gastric Banding

The surgeon places an adjustable band to create a small pouch on the upper part of the stomach to limit food intake.

4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

This surgery involves removing a portion of the stomach and bypassing most of your small intestine. It limits both your food intake and absorption of nutrients.

Cost of Bariatric Surgery

The cost of bariatric surgery can range from Rs 2.5 lakhs to Rs 6 lakhs, as it depends on several factors. Some factors which affect the cost include —

• Patient’s overall health

If the patient has any underlying health conditions like diabetes or cardiac issues, the cost will go up.

• Type of surgery

The cost will vary depending upon the type of surgery performed – Roux-en-Y Gastric Bypass, Gastric Sleeve, Biliopancreatic Diversion with a Duodenal Switch (BPD-DS), or Adjustable Gastric Banding (AGB).

• Type of hospital

If you prefer a multi-speciality or super-speciality hospital with advanced technology, it will cost you way more than a government-run or private hospital with less infrastructure and facilities. Reputed hospitals also charge more.

• Expertise of surgeon

The expertise and experience of the surgeon who will perform the surgery also affect the cost. The fees of highly skilled and reputed surgeons are high, adding to the overall cost.

• Surgery procedures

There are two types of procedures for bariatric or weight loss surgery — open and laparoscopic. Laparoscopic surgery is costlier and has many advantages compared to open surgery.

• City

The cost is higher in cities like Mumbai, New Delhi, Hyderabad, Bangalore, and Chennai compared to tier 2 cities.

• Hospital costs

This includes doctor’s consultation fees, diagnostic tests, room rent, medications, hospitalisation, post-operative care, etc.

Does Health Insurance Cover Bariatric Surgery?

Yes. As per the guidelines by the Insurance Regulatory and Development Authority of India in 2019, bariatric surgery is covered by health insurance but under certain conditions. The policyholder has to fulfil the below criteria to avail of insurance coverage –

• Must be at least 18 years old

• The patient must have a body mass index (BMI) of 40 or higher.

• If the patient’s BMI is between 35 and 40 with comorbidities such as diabetes, stroke, or heart disease, he/she is eligible for insurance coverage.

• The surgery must be medically necessary and recommended by a qualified doctor.

• The patient must provide the doctor’s prescription and relevant test reports.

Is there any waiting period in health insurance for Bariatric Surgery?

Most health insurance plans have an initial waiting period of around 30 days for bariatric surgery. If the patient has pre-existing conditions, he/she has to wait for another 1-3 years because pre-existing diseases are covered after a waiting period of up to 3 years, depending on the insurer.

Conclusion

It’s not easy to lose weight when you are obese. If your weight remains the same in spite of your efforts to shed those extra pounds and you are at an increased risk of life-threatening illnesses, bariatric surgery is the last option. It costs lakhs but the best part is that bariatric surgery is covered under health insurance. As obesity may lead to critical illnesses like cancer, you can also consider buying critical illness insurance for additional financial protection.

FAQs related to Bariatric Surgery Health Insurance

1. Will my health insurance cover bariatric surgery?

As per IRDAI guidelines, bariatric surgery is covered under health insurance, but you need to meet certain criteria.

2. What are the eligibility criteria for coverage of bariatric surgery?

You must be at least 18 years old with a BMI of 40 and above. You must have a doctor’s prescription that surgery is medically necessary and diagnostic test reports. If your BMI is 35 to 40 with comorbidities such as diabetes, stroke, or hypertension, you can still get coverage.

3. How will I know if bariatric surgery is covered?

While buying health insurance, you must read the policy document carefully to understand the inclusions and exclusions. In case of any doubt, check with the agent or insurance company.

4. Is there a waiting period for bariatric surgery?

Yes, most health insurance plans have an initial waiting period of about 30 days for bariatric surgery. If you have any pre-existing ailment, you have to wait for another 1-3 years for availing coverage.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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