Does your Health Insurance cover Surgical treatment for Obesity?

Health Insurance and Obesity Surgery: Coverage Explained

Health Insurers have defined certain criteria based on evidence based medicine to cover Surgical treatment for obesity

1. Surgery has to be conducted upon the advice of the Doctor

2. The surgery/Procedure conducted should be supported by clinical protocols

3. The patient has to be 18 years of age or older

4. Body Mass Index (BMI); greater than or equal to 40 or greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss;

The comorbidities are

i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes

Based on the Sum Insured, the coverage limits change and the insured is eligible based on the Policy opted. The limits of the cover are based on the Sum Insured and the waiting periods apply.

Bariatric Surgery

Bariatric Surgery consists of four types of surgery. They are,
 

• Gastric bypass
• Sleeve gastrectomy
• Gastric banding
• Duodenal switch

Sleeve gastrectomy is the common weight loss surgery recommended by medical practitioners for patients suffering from Obesity.

Eligibility Criteria for Benefits

Health insurance companies might have some eligibility criteria for patients to qualify for bariatric surgery coverage:
BMI Requirement: most insurance companies will demand a BMI score of 35 or more to become eligible for coverage with other accompanying weight-related health conditions like diabetes or high blood pressure.

Proof of Medical Need: most insurance companies will require evidence by a patient's physician that the surgery is needed for health reasons.

Pre-authorization: Some insurance companies require pre-authorization before the surgery; it involves more paperwork and approvals.

Exclusions and Limitations

One needs to be aware of the possible exclusions or limitations in health insurance policies related to bariatric surgery:

Waiting Periods: Most have waiting periods for specific treatments, bariatric surgery is also included in such a category. Knowing such terms may prove helpful while avoiding getting charged at the time of treatment request. There might be sub-limits present concerning surgeries, which would impact the financial element of treatment.

Complications Post-Surgery: Though surgery is covered by the policy, some policies do not cover complications which occur after surgery.

Prevention is better than cure. Maintaining the diet and restricting yourself from added sugars and unhealthy beverages, quitting smoking and alcohol combined with daily exercises will keep your weight in control and prevent Obesity and need for surgery.

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