- Definition
- Policy coverage
- Waiting period
Simran has over 3 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
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Anchita has over 6 years of experience in content marketing, insurance, and healthcare sectors. Her motto to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
Updated on Apr 22, 2025 5 min read
Health Insurance for Bariatic Surgery
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 your 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, some do not.
This article delves 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.
Is Bariatric Surgery Covered by Health Insurance?
Yes, bariatric surgery coverage is a recently added coverage in the health insurance. In October 2019, the Insurance Regulatory and Development Authority of India (IRDAI) mandated the inclusion of bariatric or weight loss surgery within health insurance coverage. This directive aimed to provide essential medical care to individuals with obesity and related medical conditions. By incorporating bariatric surgery into family health insurance plans, individual health plans, and even critical illness insurance policies, it was projected that approximately 38% of the rural Indian population and 30% of the urban Indian population would gain access to potentially life-saving treatment.
Why Do You Need Bariatric Surgery Cover?
The cost of bariatric surgery can be hefty, it can be between Rs 2.5 Lakh to Rs 5 Lakh. However, the actual cost of bariatric surgery depends on factors like type of surgery, hospital cost, gastroenterology surgeon’s fees and much more. Having 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.
What Bariatric Surgery Cures?
Bariatric surgery resolves many health issues related to obesity. Some of the problems that bariatric surgery can cure are:
- Fatty liver disease
- Gastroesophageal reflux disease
- Arthritis
- High blood pressure
- Breathing disorders
- Urinary stress incontinence
- Cholesterol
- Asthma
- Sleep apnea
- Venous stasis
What are 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.
- Identity proof
- Doctor’s prescription
- Bills of surgical procedures
- Any other documents as requested by the insurer
What is the Waiting Period for Bariatric Surgery?
The waiting period for bariatric surgery depends on policy to policy. However, the waiting period for health insurance for bariatric surgery is mostly 2 to 3 years. So, if you want to go for weight loss surgery, then you need to wait for a few days before availing the benefits.
Types of Bariatric Surgery Procedures Covered in Health Insurance
Health insurance covers the following bariatric surgery procedures:
- Open or laparoscopic gastric bypass
- Sleeve gastrectomy
- Biliopancreatic diversion
- Laparoscopic adjustable gastric banding
- Roux-en-Y gastric bypass
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.
Exclusions of Bariatric Surgery in Health Insurance
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
We need to understand that bariatric surgery can be life-changing for anyone, but at the same time, it can be costly too. 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.
If you want to know more about health insurance for bariatric surgery, call our experts at PolicyX.com. We will give you Only Expert Insurance Advice, No Spam & No Gimmicks.
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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.
6. What if my BMI is slightly below the required threshold, but I have serious health problems related to obesity?
While insurers typically follow strict BMI criteria, some may consider exceptions if you have severe comorbidities that significantly impact your health. You’ll need thorough documentation from your doctor outlining the medical necessity of the surgery.
7. Can I get bariatric surgery covered if I’m planning to have it for cosmetic reasons?
No. Health insurance covers bariatric surgery only when it’s deemed medically necessary to treat obesity-related health conditions. Cosmetic reasons for weight loss are not covered.
8. Are all hospitals and surgeons covered under my insurance for bariatric surgery?
No. Coverage depends on your insurance provider’s network of hospitals and surgeons. It’s crucial to confirm that your chosen hospital and surgeon are in-network to avoid unexpected out-of-pocket expenses.
9. What if my insurance company denies my claim for bariatric surgery?
If your claim is denied, you have the right to appeal the decision. Gather all relevant medical records, documentation of weight loss attempts, and a letter from your doctor outlining the medical necessity of the surgery. Follow your insurance company’s appeal process.
10. Does health insurance cover post-surgery follow-up care and complications?
Coverage for post-surgery care varies depending on your policy. Check your policy documents or contact your insurer to understand what’s covered, including follow-up consultations, nutritional counselling, and treatment for potential complications.
11. Are there any specific documents I need to provide for documenting my previous weight loss attempts?
Yes. You should provide medical records from doctors or dieticians, records of participation in medically supervised weight loss programs, and documentation of any medications or therapies used for weight loss.
12. Can I use a cashless facility for bariatric surgery?
Yes, if your chosen hospital is part of your insurance provider’s network and you have obtained pre-authorization, you can avail of the cashless facility.
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Written By: Simran Saxena
Simran has over 3 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
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