Definition of Bariatric Surgery in Health Insurance

Maintaining a healthy weight can be a challenge for many of us. Weight gain, when left unchecked, quickly spirals into obesity and has plenty of undesirable consequences, including heart disease, hypertension, and diabetes, to name just a few. Usually, going down a healthy diet combined with a regular exercise route can work wonders, and you can get back to your ideal weight with some effort. Some may even require medication to cut back on the weight gain. But what happens when none of this makes a dent and the weight gain becomes excessive?

Maintaining a healthy weight can be a challenge for many of us. Weight gain, when left unchecked, quickly spirals into obesity and has plenty of undesirable consequences, including heart disease, hypertension, and diabetes, to name just...
Maintaining a healthy weight can be a challenge for many of us. Weight...
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Definition of Bariatric Surgery in Health Insurance

A surgical intervention in the form of bariatric surgery can help those who suffer from morbid obesity to get their weight and life back on track. The surgery is performed on the stomach or the intestines in a manner that helps cut down food intake, reduces hunger, or regulates food absorption, which leads to weight loss.


According to the guidelines issued by the Insurance Regulatory and Development Authority of India in 2019, bariatric surgery is covered through health insurance in the country. But the policyholder will have to meet certain conditions to avail insurance coverage for their surgery, and they are as follows:

  • The patient should be 18 years or older
  • Their body mass index (BMI) should be 40 or higher
  • Comorbidities such as diabetes, heart disease, and hypertension can entitle coverage for those whose BMI falls between 35 and 40
  • The surgery should have been recommended by a certified physician
  • The patient must provide all relevant documents, including a doctor’s prescription, diagnostics, and test reports
  • Some insurers may also ask for documentation/evidence of attempts to lose weight through diet/exercise, failing which, the bariatric surgery was advised

Is there a waiting period for bariatric surgery in health insurance?

There is a waiting period for bariatric surgery when it comes to getting coverage for it via health insurance. If the patient has no pre-existing conditions, then they will have an initial waiting period of about 30 days. If the patient does have pre-existing conditions, the waiting period will vary from 1 to 3 years, depending on the insurer.

What are the different types of bariatric surgery?

Here is a list of different types of bariatric surgeries in healthcare.

Gastric Bypass

The gastric bypass, also known as the Roux-en-Y, is a complex surgery that involves creating a small pouch in the stomach and connecting this pouch to the small intestine. This is achieved by sectioning off the stomach into a smaller pouch and a larger pouch. This surgery ensures that the food bypasses a large portion of the stomach, thus leading to weight loss by limiting food consumption and cutting down calorie absorption.

Sleeve Gastrectomy

Also known as the gastric sleeve, this bariatric surgery involves the removal of 80% of the stomach, which automatically reduces the amount of food the patient can eat. Post-surgery, only a tube-shaped stomach sleeve is left behind, leading to a reduction in hunger pangs as well.

Adjustable Gastric Band

This surgery involves the creation of a small pouch in the stomach by placing a silicone band around the upper part of the digestive organ. Food intake is reduced through this procedure, thereby leading to weight loss.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

This surgery is a two-step process wherein a gastric sleeve surgery is done and the sleeve is then attached to the end part of the intestine so that the food can bypass most of this organ. This limits food intake and nutrient absorption significantly.

What is the cost of bariatric surgery in India?

Bariatric surgery can cost anywhere between INR 1.5 lakhs to 5 lakhs in India. Several factors can influence the cost of the surgery, including the city you reside in, the type of surgery recommended, the overall health of the patient, the hospital chosen, etc.

Conclusion

Sometimes we may have tried every avenue possible except surgery to shed those excess kilograms, but to no avail. This type of weight gain will not only cause extensive damage to your physical health, but it can also impact your mental health, leading to depression. When things come to a head with weight gain, surgery may be an option offered to you. With the help of health insurance, get your life back on track with bariatric surgery.

Frequently asked questions

Yes, it is covered under health insurance if certain eligibility criteria are met.

Insurers usually have a set of eligibility criteria in place, such as age (18 and older) and body mass index standards (40 and above for those without pre-existing conditions and between 35 and 40 for those with pre-existing conditions).

There is an initial waiting period of about 30 days for those with no pre-existing conditions. Those with pre-existing conditions may have a waiting period of 1 to 4 years, depending on the insurer.

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Written by Roocha Kanade

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Reviewed by Dr. Harshita Dahiya Author info Icon

Health Insurance content enthusiast who turns complex topics into easy, binge-worthy reads—fueled by SEO, creativity, and way too much chai! Loves juggling multiple projects, cracking impossible deadlines, and sprinkling humor into the mix. When not geeking out over digital trends, you'll find her lurking on Quora and Reddit, planning the next getaway, or passionately decoding all things health and insurance!

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