Does Health Insurance Cover Bariatric Surgery?


Does Health Insurance Cover Bariatric Surgery?

Being overweight or obese can contribute to various severe health issues. Excess weight is associated with an increased risk of conditions such as heart disease, diabetes, hypertension, certain cancers, and musculoskeletal disorders. Apart from the physiological problems, being overweight can also impact your mental health, leading to conditions like depression and anxiety.

Addressing excess weight through lifestyle changes, including a balanced diet and regular exercise, is crucial in preventing and managing these health issues. In severe cases where conventional methods prove ineffective, bariatric surgery may be considered under medical supervision. Before we discuss bariatric surgery in detail, let us also take a look at how obesity affects India. We will also discuss the things you need to keep in mind when thinking about bariatric surgery and the common question, “is bariatric surgery covered by medicare?

Obesity: A Serious Issue

According to the World Health Organization (WHO), the prevalence of obesity nearly tripled from 1975 to 2016. Initially considered a problem primarily in wealthy nations, obesity is now increasingly prevalent in low and middle-income countries. In India today, it is believed that 1 out of 4 people are obese.

Obesity and Bariatric Surgery

Bariatric surgery is done when a low-calorie diet and exercise do not show positive results in lowering the weight of a person. This surgery is considered the most effective in treating class III obesity. According to the National Institute for Health and Care Research (NIHCR), class III obese patients often suffer from depression when they find that their low-calorie diet food is effective only for a short-term reduction of their weight.

This surgery saves them from other life-threatening diseases that can grapple their body due to Class III obesity. So, if you are also struggling due to obesity, you should also opt for this surgery and save your life from the risk of the following diseases:

  • Cardiovascular disease
  • Type 2 diabetes
  • Hypertension
  • Fatty liver disease
  • Heart stroke
  • Cancer risk
  • Sleep apnea

In order to undergo the same, you would have to fulfil certain medical conditions, which include screenings and investigations. Keep reading to know if bariatric surgery covered by insurance.

Who Needs Bariatric Surgery?

Bariatric surgery is an option for those obese patients whose obesity has been diagnosed clinically as Class III obesity. Your doctor will recommend bariatric surgery in two circumstances:

  1. Your body mass index is either 40 or higher than 40. This is equal to 100 pounds overweight.
  2. Your body mass index is either 35 or higher plus you are suffering from one or multiple serious health diseases such as hypertension, fatty liver, and cardiovascular disease.

Bariatric Surgery and Aftermath

After bariatric surgery, your gut (gastronomical tract) system will be affected. You will not be allowed to take solid food for 1 to 2 days. This time period is essential to restore the health of the digestion system. You’ll be allowed to take only liquid. Afterwards, for a few weeks, you will have to follow a strict dietary chart. Your diet will start with liquids to see how your digestive system responds to them. Then, it will gradually shift from liquid food to puree, and then, to soft food. When your digestive system starts functioning well, you will be allowed to eat solid food (regular food).

Keep in mind that your visits to the doctor will not end after the surgery. You will have to undergo several blood tests and other diagnosis tests for the first several months, so, regular follow-ups will be required. Recently, an NIHCR study confirmed that poor weight loss after surgery can lead to two significant problems after bariatric surgery i.e. inflammation and depression.

Is Bariatric Surgery the Best Way to Weight Loss?

Sadly no, Surgery is not a standalone solution; it requires a commitment to lifestyle changes. While the surgery can be an effective tool for weight loss, its success depends significantly on your commitment to making consistent lifestyle changes.

Bariatric surgery is not a quick or permanent fix on its own; it's a way that requires dedication to new dietary habits, regular exercise, and emotional well-being.

Health Insurance Bariatric Surgery Coverage

Simply put, bariatric surgery is covered by insurance, however, health insurance for bariatric surgery is possible only in certain conditions. The Insurance Regulatory and Development Authority of India mandates health insurance companies to offer coverage for bariatric surgery. However, the surgery is covered only when it is prescribed by a doctor because of the insured’s health condition. Please note that elective bariatric surgery, where the aim is only to improve aesthetic appearance, will not be covered. If you want to know which health insurance covers bariatric surgery, you should know that most plans will cover your expenses only when the surgery is medically necessary.

>> Also Read: Health Risks of Being Overweight

Things to Know When Thinking about Bariatric Surgery

If you are thinking about bariatric surgery, you should know some vital points related to the surgery such as the procedure, any possible complications and outcomes. This will help you prepare for everything that will come along with the surgery. 

1. Know the Procedure

Understanding the intricacies of bariatric surgery is crucial before proceeding. Consult with your surgeon beforehand. Comprehensive awareness about the surgery will contribute to your mental preparedness, reducing the likelihood of feeling overwhelmed or anxious during the process.

2. Consult Your doctor and Family

Make sure you share your health concerns with your doctor.  This will help in the evaluation of the surgery's potential risks, and also manage your expectations. It is recommended that you do not make this decision in isolation. Bariatric surgery is a major surgery, so try to engage in open dialogue with your family members. You will need their support not just after the surgery but also throughout the extended recovery period.

3. Find Out- Will Medicare Cover Bariatric Surgery?

If you’ve make up your mind to go for the surgery then make sure you have the best individual health insurance that covers bariatric surgery. Check out whether your health insurance medicare plan offers bariatric surgery health insurance coverage, is there any waiting period or sub-limit etc. If you have insurance that will cover bariatric surgery, you should work towards selecting the network hospital for the surgery and other diagnostic tests.

4. Weigh the Pros and Cons

Whether or not the bariatric surgery covered by insurance, you should weigh the pros and cons before undergoing the surgery. Your ignorance can make you suffer from severe consequences like depression due to poor body weight. Additionally, recognize the significant lifestyle adjustments required for an extended period. Changing eating habits will be essential, and the transition from soft foods to favourites might take considerable time. Be prepared that it may take a long time for you to be ready to switch from soft food to your favourite food again.

5. Look for any Alternative Approaches

Experts suggest that opting for bariatric surgery should be a last resort. You need to acknowledge its effectiveness in weight reduction but also recognise the associated complications. It is true that it will help you in reducing the weight but it may come with its set of complications and risk factors. Some patients complain of abnormalities in the digestive tract system and inflammation after surgery.

Before making a decision, it's advisable to thoroughly research and discuss various alternative approaches with healthcare professionals to determine the most suitable and least invasive approach tailored to individual health needs.

Summing it Up

If you are considering bariatric surgery, you should first consult healthcare professionals to assess its appropriateness based on your unique health circumstances. You may be suggested to explore alternative options before making such a significant decision. If, however, you have been suggested surgery, then it is advisable to be sure about, “Does medical cover bariatric surgery”. It is also suggested that you thoroughly review your insurance policy, understand the coverage details, and work closely with your healthcare provider to gather the necessary documentation.

Care Health Insurance has introduced customised health insurance plans that offer coverage for a list of  diseases that can occur due to obesity including Type 2 diabetes, cancer, cardiovascular diseases etc. These plans are structured to offer financial support for various healthcare needs, ensuring that you and your loved ones can access the necessary treatments without a significant financial burden.

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.

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