Does Insurance Cover Weight loss Surgery?

Weight loss surgery, often referred to as bariatric or metabolic surgery, is a category of surgical procedures that are performed to help people with obesity lose weight. Weight loss surgery is usually recommended by healthcare providers when traditional, non-surgical methods of weight loss have been ineffective. 

Before finalizing weight loss surgery, however, it is important to understand if it is covered by health insurance and what specific procedures are covered by your insurance. 

In most cases, weight loss surgeries are covered by health insurance plans but only if certain criteria are met by the patient. So let us discuss not only what requirements you need to meet before your insurance provider can provide coverage for your procedure but also what the cost of your surgery might be, what the extent of the coverage may be, if there is any waiting period before coverage can be provided and the exclusions and inclusions you need to consider before going forward with the procedure.

How much does weight loss surgery cost?

The average cost of weight loss surgery in India can range anywhere from Rs. 1,00,000 to Rs. Rs. 5,00,000. It is also to be noted however, that depending on several factors such as the city you undergo surgery, severity of your obesity, type of surgery and cost of preoperative tests and diagnostics, the exact cost of your surgery is likely to vary. 

• The minimum cost of weight loss surgery in India can be Rs. 1,00,000
• The average cost of weight loss surgery in India can be Rs. 2,93,000
• The maximum cost of weight loss surgery in India can be Rs. 5,00,000

Is weight loss surgery covered by insurance?

Yes, weight loss surgeries are usually covered by most health insurance plans in India. Morbid obesity, a condition in which a person’s BMI is 40 or higher, can be life-threatening and when all non-surgical methods are deemed ineffective, surgery often remains the only solution. If  surgery is delayed even further however, it can lead to serious consequences such as hypertension, type 2 diabetes, increase in blood pressure and sleeping disorders. It is to be kept in mind that before health insurance policies provide coverage for weight loss surgery, certain criteria needs to be met, such as:

• You must be at least 18 years of age
• Your BMI or Body Mass Index is 40 or higher
• Your BMI is 35 but you suffer from comorbidities such as diabetes, heart disease or stroke
• You must provide your doctor’s prescription and relevant diagnostic test reports to claim coverage

Documents needed to raise a claim for weight loss surgery

For weight loss surgery insurance claim, you may need to provide certain documents which are given below:

• Medical reports and your history of obesity related health problems
• Evidence of treatment attempts with different approaches to diet and lifestyle changes
• Proof of unsuccessful attempts at weight loss while undergoing pharmacological therapy, if applicable.

Is there any waiting period in health insurance for weight loss surgery?

Many insurance companies require a patient to serve a waiting period of a certain duration from their initial approval to the actual surgery. This waiting period for health insurance applies for patients planning to undergo weight loss surgery as well and can range anywhere from 2-4 years. To simplify even further, if you want to claim weight loss surgery expenses, you can do so only after the completion of the waiting period post-policy purchase. It is also often advised to opt for such a benefit with your first insurance policy as well.

Exclusions under health insurance for weight loss surgery

When it comes to insurance coverage for any kind of surgical procedure, there are certain exclusions that need to be considered and understood before a claim can be raised. Prior to surgery, it is important to have a detailed discussion about the exact inclusions and exclusions with your insurance provider. The following are the usual exclusions for weight loss surgery under health insurance.

• Claims cannot be raised during the initial waiting period of the plan. This period may last around 30 days.
• As is the case with any other cosmetic procedure, weight loss surgery is not covered under insurance if it is being undertaken for cosmetic or aesthetic reasons.
• Pre-existing conditions related claims are generally not covered under health insurance plans.
• If your weight gain is a byproduct of medication, poor mental health, poor eating habits or poor quality of life, expenses for your weight loss surgery may not be covered.

Financial coverage for weight loss surgery is generally not included in a basic medical insurance policy. However, nowadays, insurance providers offer an option to include weight loss surgery as an add-on cover for an additional premium. Prior to making any decision, it is always wise and advisable to have a detailed discussion about the specifics of your insurance policy with your insurance provider. While coverage of weight loss in insurance plans is becoming more and more normalized and customer-friendly nowadays, it is also important to perform detailed and proper research before buying any health insurance plan online.