Understanding Bariatric Surgery Insurance Coverage for Morbid Obesity in India

Obesity is a complex disease involving genetics, metabolism, hormones and life style. Morbid obesity which is also termed as severe obesity is a disease and it is approved as a disease by all medical councils, insurance companies, Govt, etc.

Just like any other diseases, IRDAI, Insurance Regulatory and Development Authority of India have approved morbid obesity as a disease. Hence treatment for morbid obesity including metabolic and bariatric surgery is covered under insurance.

What is morbid obesity :

Asian and Indian guidelines state that anyone with a BMI of 32.5 with obesity associated conditions or anyone with a BMI of 37.5 or above is termed to have morbid obesity.
However, Indian insurance companies have limited the insurance cover for the following:

• Anyone with a BMI above 40kg/m2 with obesity induced symptoms
• Anyone with a BMI above 35 with either uncontrolled type 2 diabetes or severe sleep apnoea or coronary heart disease.

Note : There is no definition for ‘severe’ sleep apnoea and hence a document or report or a specialist certificate is necessary.

Uncontrolled diabetes is when the HbA1c, or three months average sugar is above 7, or multiple blood sugar levels are very high; in spite of medical treatment for diabetes.
It is important to preserve all earlier medical record including prescriptions, doctors consultation notes, reports, etc.

Ideally a unit with two bariatric surgeons is preferred so that two bariatric surgeons can certify for the patient.
Patients are expected to preserve all records of earlier weight loss attempts.

Even though severe osteoarthritis, PCOS, migraine, urine incontinence, high lipid levels, knee or spine diseases, etc are also few of the main indications for bariatric surgery, insurance companies in India do not accept these for bariatric surgery cover. It is still recommended to have the documents related to the above as supporting documents.

When can one get insurance cover for bariatric surgery after having the insurance?

Some insurance companies have a waiting period of two to four years after the date of inception, that means from the date on which insurance was first stared.

Corporate insurance does not have any waiting period.

If you are suffering from morbid obesity and associated problems, metabolic and bariatric surgery is the best long term solution for you. If you have a valid insurance cover, you deserve to get insurance cover for the same.