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Jun 15, 2024

Health Insurance for Weight Loss Surgery: Coverage, Qualifications, Types

Weight loss surgery is a primary procedure for people with severe obesity to facilitate safe weight loss. However, the cost of bariatric surgery can be prohibitive for many individuals. Fortunately, most health insurance policies in India now cover bariatric surgery, making it more accessible to those in need. This blog will discuss bariatric surgery insurance and things to consider to ensure your health coverage includes this procedure.

Understanding Bariatric Surgery Coverage

Bariatric surgery was not common in health insurance policies in India until the implementation of the 2019 Insurance Regulatory and Development Authority of India guidelines. The guidelines mandate all health insurance companies to include bariatric surgery as part of coverage under specific terms and conditions. One thing to keep in mind is that bariatric surgery coverage is limited to being useful and necessary. If the surgery is elective and solely wished for cosmetic purposes, it will not be accepted. In contrast, when one’s health insurance company approves bariatric surgery, it is considered a recommended treatment for metabolic diseases related to obesity.

Qualification for Bariatric Surgery

The following are the major requirements top insurance companies like Bajaj Allianz consider for bariatric surgery coverage:
  1. Eligibility: The minimum age to be eligible for bariatric surgery should be 18 years.
  2. Body Mass Index (BMI): Your BMI must be above 40, but a BMI over 35 may be acceptable if associated with comorbid conditions.
  3. Doctor Recommendation: A qualified doctor’s approval to undergo surgery based on prior diagnosed diseases and having a record of your medical history is needed for your cover approval.
  4. Pre-surgery requirements: Prior conservative documented methods for weight loss must be used and tried before surgery is practised.

Types of Bariatric Surgery Procedures Covered

The types of bariatric surgery procedures covered by your health insurance coverage vary from insurer to another. Nonetheless, highly covered bariatric surgery procedures include:
  1. Laparoscopic Roux-en-Y Gastric Bypass: This approach is the most popular and modifies the digestive tract to control food consumption.
  2. Laparoscopic Sleeve Gastrectomy: The operation involves removing a portion of the stomach, reducing the size of the stomach pouch and consumption.
  3. Laparoscopic Biliopancreatic Diversion with Duodenal Switch: This bariatric surgery is more ambitious and involves changing the size of both the stomach and small intestines, therefore, severely limiting caloric consumption.

Factors Affecting Bariatric Surgery Coverage

Other factors to determine if your health insurance covers bariatric surgery include:
  1. Policy exemptions: It is advisable to read the coverage plan details and identify any policy statements on bariatric surgery; there may be popular exceptions.
  2. Pre-existing illnesses: Several insurers may decline coverage due to underlying health problems; it is better to know more.
  3. Network providers: All network teams spend less out-of-pocket fees to identify in-network practitioners and medical organisations participating in your insurance policy.

Steps to Take for Bariatric Surgery Coverage

Follow these steps to get your bariatric surgery coverage:
  1. Contact Your Insurer: Visit your insurance provider and request bariatric operation coverage information.
  2. Documentation: Collect your doctor’s referral databases, existent professor, and verification of attempts to lose weight.
  3. Pre-Approval: To accommodate the reduced cost of the bariatric operation at audited medical centres, receiving pre-approval from your insurance provider before undergoing the surgery is a smart idea.

Bariatric Surgery and Long-term Care

The operation is just the start of your journey to lose weight. You must adopt a new approach to diet and physical activity to be effective in the long term. You must also be aware that complications may arise that necessitate further surgical operations. Therefore, make sure your insurance covers any potential future operations. Alternatively, not everyone has to go under the knife and struggle for years with weight loss. Your insurance plan may offer non-surgical options like weight reduction programs or drugs that such products were part of the policy all along. This could be a good first step to achieve the desired result. If you are looking for a health insurance plan that covers bariatric or weight loss surgery, apply for Bajaj Allianz Health Insurance on our website today!

FAQs

1. Does insurance cover weight loss surgery?

Yes, many health plans cover bariatric surgery if deemed medically necessary, but criteria and limitations apply.

2. What factors affect bariatric surgery coverage?

BMI, medical necessity, pre-surgical attempts at weight loss, policy exclusions, and in-network providers all play a role.

3. How do I know if my insurance covers bariatric surgery?

Review your policy documents or contact your insurance provider directly for clarification.

4. What steps should I take if I'm considering bariatric surgery?

Review your policy, consult your doctor, seek pre-authorisation, and understand out-of-pocket costs.

5. What are some additional things to consider?

Appeal process, non-surgical weight loss options, and long-term commitment to lifestyle changes.   *Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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