)
While medical practitioners are seeing a rise in obesity-reduction surgeries, it may still take time before health insurance cover is made available for these procedures. On one hand while the surgeons are requesting for bariatric surgeries to be excluded from cosmetic surgery category, insurers are not comfortable covering this procedure.
Bariatric surgery involves a surgical procedure wherein the size of the stomach is curtailed leading to reduced consumption of calories. Bariatric surgery not only cures obesity but also its allied ailments.
Dr. Muffazal Lakdawala, Founder, Centre for Obesity and Digestive Surgery (CODS) said that most developing nations have passed regulations to ensure bariatric surgeries are provided insurance cover. 'Insurers here are not ready to provide cover for these procedures. Bariatric surgeries cannot be considered as a cosmetic surgery. Customers should be given the opportunity to choose whether they want to take an insurance cover or not,' he said.
Insurance Regulatory and Development Authority (Irda) regulations have excluded cosmetic surgeries from the purview of health insurance coverage. This is to ensure that the insurance companies are not made to pay for such procedures undertaken by a customer for various purposes. Further, with the cost of surgeries ranging from Rs 2 lakh to several lakhs of rupees depending on the exact nature of surgery.
Insurance companies too, are not comfortable with offering a cover for these ailments. A senior official of a private general insurance company said that most cases of bariatric surgeries are for cosmetic purposes and hence it is difficult to ascertain under which category the surgery falls and if it is life-threatening.
Experts of the industry pointed that though doctors may insist that such procedures could be a life-saver in several cases, they had experienced it otherwise. The claims in these cases would not be manageable, they added.
The medical community, however, has a different perspective. Ashish Pandit, a senior surgeon with a large New Delhi-based hospital explained that they had dealt with several complex cases where patients had come for weight-management operation due to medical necessities. 'While it may not be considered as a high-risk procedure, it is a life-saving process in several cases. Hence, it is prudent that these cases are also covered by insurance,' he explained.
Adding to this, Lakdawala said that in countries like US, insurers can refuse a claim of a patient with obesity-related ailments, if he/she had earlier refused an offer for a bariatric surgery to treat it.
Indian insurers do not have mechanism to check whether such claims are genuine or not. Segar Sampathkumar, general manager at New India Assurance, which is one of the largest players in the health insurance segment, it is difficult to offer cover due to the complexities involved with the procedures. Hence. he added that these surgeries are excluded from cover.
Looking forward, insurers believe that it would be imprudent to offer coverage, for these treatments, to protect the transparency of the health insurance regulation. 'Rather than having it as part of insurance cover for rare cases where patients would have doubts about their claims being paid by the company, it is presently appropriate to let it remain as an exclusion. We do not have the data to determine premiums for these covers and neither have statistics to prove that they are of utmost necessity in India,' an official with a general insurance firm said.
