Health insurance for bariatric surgery


Know What is Bariatric Surgery – Edelweiss General Insurance Blogs

26th July 2022 8min read 416 views

Health insurance plans provide financial stability when you need it most. They enable you to take charge of your illness and subsequent recovery. Health insurance helps take care of the cost of medical treatments, allowing you to focus on getting better. If you have healthcare insurance, you have probably noticed a few exclusions. Your health policy will not cover particular treatments or situations that caused harm. One procedure that many people worry is not covered is bariatric surgery.

What Is Bariatric Surgery?

Bariatric surgery is also known as weight-loss surgery. It’s performed on individuals who are obese, which puts them at a high risk of developing comorbidities. Doctors may recommend the procedure for people who struggle with being overweight despite exercising regularly. Four procedures fall under the purview of bariatric surgery:

  • Gastric bypass - The procedure is also known as a Roux-en-Y, which creates a small pouch from the stomach and connects is directly to the small intestine.
  • Sleeve gastrectomy - In this procedure, doctor’s remove around 80% of the stomach, leaving only a small sleeve that limits the person’s food intake.
  • Laparoscopic adjustable gastric banding - Also known as LAGB, the procedure involves wrapping a band around the top of the stomach, leaving a very small stomach pouch that makes the person feel full faster. The band can be adjusted by increasing or decreasing the amount of fluid that sits in a balloon around the band.
  • Biliopancreatic diversion with duodenal switch - Sometimes called BPD/DS or simply duodenal switch, the procedure closes off part of the stomach with staples and reduces the length of the small intestine, limiting the amount of food a person can consume. It is not a very common procedure as it may lead to other complications and nutritional problems over time.

After the surgery, patients must focus on their recovery. They may need various follow-up procedures and meetings with nutritionists and other healthcare experts.

When Is Bariatric Surgery Necessary?

Doctors recommend a bariatric surgery for individuals who are unable to lose weight after exercising and following a healthy diet. Without the surgery, obese individuals have a higher chance of suffering from:

  • Stroke and cardiovascular diseases
  • Hypertension
  • Diabetes
  • Fatty liver disease
  • Sleep disorders like sleep apnoea

If individuals put the surgery off, they risk increasing their chances of developing these health conditions, which could further impact their health.

The Cost of Bariatric Surgery

Bariatric surgery could cost between INR 2,50,000 to INR 5,00,000 or more, depending on the doctor and healthcare facility. In addition to the procedure, individuals need to think about after-surgery care and follow-up procedures, if any. Given that bariatric surgery could be required to ease an individual’s health issues, the Insurance Regulatory and Development Authority of India (IRDAI) made it mandatory for insurance companies to offer coverage for the surgery under their Mediclaim policy plans.

Bariatric Surgery and Medical Insurance Plans

For a health plan to cover the cost of bariatric surgery, you must meet a few conditions. You can only file a claim against the surgery if:

  • A surgeon has prescribed diagnostic tests for the surgery
  • The covered individual has a BMI of at least 40
  • The individual has all medical reports that reflect the surgery is necessary

Some people choose to undergo bariatric surgery for cosmetic or aesthetic reasons. Others may require the surgery to fix a pre-existing condition that does not fall under the purview of their healthcare insurance policy. These individuals cannot raise a claim for the surgery.

Choosing Health Insurance Plans for Family That Cover Bariatric Surgery

Today, most insurance companies offer health insurance plans with bariatric surgery coverage. Before buying a health insurance policy for your family, you must check whether the procedure is covered. You should also check the waiting period. Most insurance companies will only cover bariatric surgery under your medical insurance for family plan after a waiting period of at least two years. Some companies extend the waiting period to four years.

When the time comes to purchase health insurance, you must check the inclusions and exclusions. If you worry that you or somebody in your family may struggle with weight issues in the future, choose a policy that covers bariatric surgery. At Edelweiss General Insurance, we offer coverage for the procedure under our gold and platinum health insurance plans. Visit the website today to purchase the ideal healthcare insurance policy for your needs.

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