Insurance Gaps in Bariatric Surgery Access in India
Context
A survey by the Obesity and Metabolic Surgery Society of India has revealed persistent insurance-related barriers in accessing bariatric and metabolic surgery. Despite IRDAI’s 2019 mandate for coverage, delays, denials, and complex processes continue to hinder timely treatment for severe obesity, a rapidly growing health concern in India.
Study Overview
Conducting Body – Obesity and Metabolic Surgery Society of India, a not-for-profit association of bariatric and metabolic surgeons.
Study Title – The Surgeons’ Perspective on Insurance Coverage for Metabolic and Bariatric Surgery for India, published in Obesity Surgery journal.
Coverage – Surveyed 109 bariatric surgeons across multiple states from November 2024 to March 2025.
IRDAI Mandate – Coverage required for metabolic and bariatric surgery since 2019 when medical criteria are met.
Nature of Obesity
Medical Condition – Obesity is a chronic, progressive disease linked to diabetes, hypertension, sleep apnoea, heart disease, infertility, and several cancers.
Not a Lifestyle Issue – Surgeons emphasise that obesity cannot be treated merely as a lifestyle flaw.
Role of Bariatric and Metabolic Surgery
Effectiveness – Reduces body weight by 30 to 40 percent and reverses many associated comorbidities.
Treatment Gap – Limited insurance support delays or prevents access to this life-saving intervention.
Delayed Approvals
Approval Time – 95.4 percent of surgeons reported that patients delay surgery due to slow insurance authorisation.
Low Patient Awareness
Lack of Information – 76.1 percent of surgeons said patients are unaware that bariatric surgery is covered when medical criteria are fulfilled.
Complex Approval Process
Process Difficulty – 69.7 percent rated the procedure as complex.
More Cumbersome – 91.7 percent believe the insurance process for bariatric surgery is more difficult than for routine surgeries.
High Denial Rates
Extent of Denials – One-third of surgeons reported denial rates between 50 and 75 percent.
Reasons – Obesity exclusions, waiting periods, and documentation discrepancies.
Financial Burden on Patients
Out-of-Pocket Costs – 81.7 percent of surgeons noted significant financial expenses despite insurance coverage.
Implementation Barriers
Inconsistent Application – Insurance provisions remain unevenly implemented, causing treatment delays, worsening complications, and higher long-term costs.
Rising Obesity Burden
Future Projections – India’s obesity prevalence is expected to triple by 2040, posing major public health challenges.
Recommended Measures
Lower BMI Thresholds – Surgeons support reducing the required BMI levels and expanding comorbidity coverage.
OSSI Guidelines – Recommend surgery for BMI 35 kg/m² or above, or above 30 kg/m² with comorbidities.
IRDAI Criteria – Coverage currently limited to BMI 40 kg/m² or BMI 35 kg/m² with severe comorbidities.
Need for Improved Accessibility
Insurance Viewpoint – Insurers should recognise obesity as a medical disease requiring accessible treatment.
Process Reform – Faster approvals and simplified procedures are essential.
Additional Reforms
Clarity and Compassion – Insurers should offer clearer policies and reduce unnecessary paperwork.
Inclusion of Related Conditions – Conditions like type 2 diabetes should be included to widen eligibility.
Streamlined Documentation – Reducing bureaucracy can significantly improve patient access.
Conclusion
Bariatric and metabolic surgery is a scientifically validated, disease-modifying intervention and not a cosmetic treatment. Ensuring wider and smoother insurance coverage is vital to improving patient outcomes, reducing long-term healthcare expenditures, and strengthening India’s response to the rising obesity epidemic. Expanding eligibility, simplifying procedures, and enhancing awareness can help deliver timely and life-saving care to millions.
Source : The Hindu