Is Bariatric Surgery Covered By Insurance?
About Bariatric Surgery:
Bariatric surgery, sometimes referred to as weight loss surgery, is a viable therapeutic option for those with severe obesity and certain associated medical disorders.
Bariatric surgery’s main objective is to help people lose weight, but studies have shown, as well as we have noticed in patients operated at Aastha Bariatrics that it also has considerable advantages for treating or controlling a number of obesity-related diseases.
Cost of Bariatric Surgery:
In India, bariatric surgery can cost anywhere between Rs. 2,80,000 to Rs. 6,00,000. The price of the procedure is not known in advance and is dependent on a number of variables, including the patient’s underlying medical issues, Grade of obesity, the hospital and the surgeon’s fees, and more.
IRDAI Guidelines for Mediclaim:
You might be wondering if bariatric surgery is covered by health insurance or about weight loss surgery insurance. Fortunately, health insurance now covers bariatric surgery according to the regulations outlined by IRDAI (Insurance Regulatory and Development Authority of India) in 2019.
IRDAI has now accepted that bariatric surgery is not just cosmetic surgery. They are now giving bariatric surgery insurance.
Chapter III, point “F” of the IRDA circular lists one of the significant recommendations. This explains why, despite the fact that every insurance provider may seek to increase the availability of health insurance coverage to patients undergoing bariatric procedures, insurance policy contracts may permit costs associated with the surgical treatment of obesity if the following criteria are met:-
Surgery is performed on a doctor’s recommendation.
Clinical procedures are used to assist the surgery or procedure.
The member is at least 18 years old.
You have a mediclaim policy which is at least more than 4 years old.
Body Mass Index (BMI):
More than or equal to 40 or
More than or equal to 35 in conjunction with any of the following severe comorbidities following failure of less invasive methods of weight loss:
Obesity-related cardiomyopathy
Coronary heart disease
Severe Sleep Apnea
Uncontrolled Type2 Diabetes
Mediclaim for Bariatric Surgery:
Mediclaim or health insurance in bariatric surgery can vary depending on several factors, including your specific Mediclaim plan, your medical condition, and the criteria set by the Mediclaim company. Generally, medical Insurance does not cover weight loss surgery, including bariatric surgery, when it is performed solely for the purpose of weight loss.
It’s important to note that even if you meet the criteria, mediclaim may require additional documentation and pre-authorization before approving coverage for the surgery. It’s recommended to contact your specific Mediclaim plan or speak with a healthcare professional who specializes in bariatric surgery to understand the coverage details, requirements, and potential out-of-pocket costs associated with the procedure.
It’s worth noting that Mediclaim Advantage plans, which are private health insurance plans approved by mediclaim, may have different coverage guidelines and may offer coverage for bariatric surgery. If you have a mediclaim plan, you should contact your plan directly to inquire about coverage for bariatric surgery.
Earlier Bariatric surgery wasn’t covered under mediclaim. But after the hard work of bariatric surgeons and their teams, mediclaim for bariatric surgery has been approved since October 2019. Various companies provide insurance that covers bariatric surgery including Star Health, New India Assurance, Hdfc Ergo and many more. But whether or not it gets approved depends from hospital to hospital.
While HDFC ergo has processed the highest number of mediclaims for Aastha hospital patients.
Infact, Aastha hospital being the Centre of Excellence in Bariatric and Metabolic, does not have difficulties in processing the mediclaims.
Approval process of mediclaim for bariatric surgery requires certain documents. Within a few days to a few weeks, you may know if the amount will be given for cashless or will be reimbursed.
