Understanding Bariatric Surgery Coverage
  • What is Bariatric Surgery
  • Does your policy cover it?
  • How to determine?
Understanding Bariatric Surgery Coverage
Buy Policy in just 2 mins

Buy Policy in just 2 mins

Happy Customers

2 lakh + Happy Customers

Free Comparison

Free Comparison

Customized Health Insurance Plan for you.

Get upto 15% Online Discount*

Select Members You Want To Insure

Age of Eldest Member

Is Bariatric Surgery Covered by Health Insurance?

If you are thinking that bariatric surgery is a solution to your weight loss management struggles, then the most important question will be whether the procedure is covered by youth health insurance or not. Bariatric surgery is an important step towards a better lifestyle and health, but you have to be aware of the financial aspect as well. Though some companies provide coverage for Bariatric surgery while some do not. This article will delve into the topic of bariatric surgery covered by insurance, helping you navigate the complex world of health insurance and its relation to the weight loss procedure.

What is Bariatric Surgery?

Bariatric surgery or weight loss surgery is a medical procedure designed to help people struggling with obesity. The surgery involves some techniques, such as gastric bypass, gastric sleeve, and gastric banding. It modifies the size of the stomach and its connection to the small intestine. The main aim of these procedures is to limit the amount of food intake, induce a sense of fullness with smaller portions, and alter the hormonal responses to food.

Why do you need a Biatric Surgery Cover?

The cost of bariatric surgery can be hefty. Health insurance for bariatric surgery can reduce the financial burden and encourage you to make decisions that will improve your overall health and well-being.

Make Health Your Top Priority Banner

Complete Health Suraksha Banner

Types of Health Insurance Plans

There are several health insurance plans that cover bariatric surgery, though they can differ accordingly. But these three main types are plans are easier to understand:

  • Health Maintenance Organization (HMO) The HMO plans require a referral from the primary care physician and limit coverage to the in-network providers.
  • Preferred Provider Organization (PPO) You will get more flexibility in choosing healthcare providers, both in and out of network in PPO plans. But it may involve higher out-of-pocket costs.
  • Exclusive Provider Organization (EPO) EPO is the hybrid of HMO and PPO plans, which provides coverage within a network of healthcare providers, excluding emergency cases.

What is the Criteria for Bariatric Surgery Covered by Insurance

There are several criteria that insurance companies have that patients must meet to be eligible for bariatric surgery coverage. These criteria include:

  • Body Mass Index (BMI) Patients with a BMI above 40 or 35 with obesity-related health conditions may qualify.
  • Documentation of Weight Loss Efforts The insurance companies require some details and documents of your previous attempts to lose weight through medically supervised programs.
  • Medical Necessity The doctor’s assessment of the health condition and potential benefits of the surgery are also a few important criteria to get covered.

How to Determine the Coverage?

  • Review your Policy Read your health insurance policy carefully and understand all the things that are being covered in it.
  • Contact your Insurance Provider Talk to your expert guide to know more about the Bariatric surgery coverage and the requirements.
  • Consult a Bariatric Surgeon Discuss the options and your potential eligibility for the weight loss journey with your surgeon.
  • Gather Documentation Collect all the necessary records and medical histories including weight loss documents and referrals.
  • Submit your Preauthorization Request Contact the doctor and their office to submit a preauthorization request to your insurance company.

Be Prepared with the Documentation

There are a few steps that need to be followed to get approval for insurance for bariatric surgery, such as medical assessment, document submission, and attending sessions. Be prepared to navigate through these documentation processes to increase the chances of approval.

Researching Bariatric Surgery Costs

The cost of bariatric surgery can differ based on several factors the type of procedure, experience of the surgeon, and the location of the center. You should go for this research and compare the costs of different providers for an informed decision.

How much time will it take to get the approval?

The approval process for bariatric surgery can vary as per the company. Some insurance providers take a few weeks while others take only a few days.

Documenting Weight Loss Efforts

Most of the time companies require evidence of your previous attempts at weight loss through supervised programs. Keep track of these programs in which you have participated for your reference. Following is the list:

  • Medical reports include a history of obesity-induced problems.
  • Any evidence of undergoing dietary and lifestyle changes for weight loss.
  • Proofs of any unsuccessful attempts at weight loss while undergoing pharmacological therapy.

What are the Exclusions?

Some of the usual exclusions for Bariatric Surgeries under health insurance are:

  • You cannot raise the claim during the initial waiting period of the plan.
  • In pre-existing conditions, Bariatric surgery does not get covered.
  • If you are going through this surgery due to any cosmetic or aesthetic reason, then it will not be covered.
  • If the weight gain is a byproduct of medication or poor mental health, the surgery for the same may not be covered.

Conclusion

To sum up, we need to understand that bariatric surgery can be life-changing for anyone, but at the same time, it can be costly too, and navigating bariatric surgery coverage can be complex. But understanding your policy and meeting the criteria are some of the important ways by which you can make informed choices related to your bariatric surgery and weight loss journey.

Understanding Bariatric Surgery Coverage: FAQs

1. Is bariatric surgery covered by health insurance?

Nowadays, health insurance covers bariatric surgeries too with specific terms and conditions.

2. What is the average cost of bariatric surgery in India?

The cost of bariatric surgery in India ranges from Rs. 2 lakhs to Rs. 6 lakhs. Moreover, the cost of the surgery depends on several factors

3. What is included in bariatric surgery?

The procedure of bariatric surgery includes gastric bypass, sleeve gastrectomy, gastric band, and duodenal switch.

4. What is the minimum weight for bariatric surgery?

The average weight of a patient should be 100 pounds and have a BMI of 40 to be eligible for bariatric surgery.

5. Can a normal-weight person get a gastric bypass?

Having a 35 BMI index or higher, obesity-related conditions, heart disease, or severe sleep apnea can go with gastric bypass.

Health Insurance Companies

What Our Customers Have to Say

Customer Review Image

Achintya Sharma

Ranchi

May 10, 2024

I’ve been covered by HDFC ERGO Platinum Health Guard plan for years now, and it has been a lifesaver. The coverage is extensive, and the claim process is so easy. I highly recommend the p...

Customer Review Image

Parag Mehta

Jamshedpur

May 10, 2024

I’m impressed with the assistance of the ManipalCigna Prime Senior Insurance policy that I’ve bought for my father. I don’t fear now being a NRI because I’m assured of h...

Customer Review Image

Anshul Garg

Vishakapatnam

May 10, 2024

The ManipalCigna LIfestyle Protection Critical Care Policy has coverage for up to 30 critical illnesses with a sum insured of up to 25 Crores. If you’re searching for a policy like this, ...

Customer Review Image

Shivalika Varghese

Delhi

May 10, 2024

If you are searching a health insurance like ManipalCigna ProHealth choose that offers straightforward claim assistance and the flexibility to optimize your coverage, go for it.

Customer Review Image

Pratibha Chandrakar

Kolkata

May 10, 2024

I was majorly focused on pre and post-hospitalization expenses coverage and found the best health coverage for these with the ManipalCigna ProHealth insurance policy.

Customer Review Image

Kanupriya Ghadge

Nagpur

May 10, 2024

For anyone who’s looking for a comprehensive health insurance policy, I would recommend buying the ManipalCigna ProHealth Prime insurance plan as it provides maximum coverage.

Customer Review Image

Neelam Sharma

Bengaluru

May 10, 2024

Star health has been my health insurer for more than 2 years and I am happy. Thanks to PolicyX for suggesting me Star Health

Customer Review Image

Adi Kukreja

Jalandhar

May 10, 2024

My wife fell ill and was diagnosed with jaundice, due to which she had to be hospitalised for a week. But Star’s Family Health Optima Insurance Plan helped me pay the bill and PolicyX mad...

Sahil Singh Kathait

Written By: Sahil Singh Kathait

Sahil is a passionate content writer with over two years of expertise in the insurance domain. He uses his knowledge in the field to create engaging content that the customer can relate to and understand. His passion lies in simplifying insurance terminology, ensuring a hassle-free understanding for potential policyholders. With his outstanding collaborative efforts with people, he understands different perspectives and keeps readers' viewpoints at the forefront of his content writing approach.