Health insurance cos reluctant to cover bariatric surgery

At a time when the Madhya Pradesh government has decided to reimburse the cost of obesity surgery to the government employees, their dependents and even needy private individuals, the health insurance companies are yet to provide the cover to patients, who may be susceptible to obesity or are obese, the problem which is affecting a number of patients and taxing them heavy on their health.

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Mahesh Kandhari, a patient, who had undergone a surgery, said, “I had an appendix surgery last year for which I put up a claim. I got about 30 per cent of the expenses incurred on the surgery. This year, doctors suggested for going under knife for obesity. As insurance companies do not cover the surgery under the policy, I had to pay it from my pocket. Thanks to the doctors, who considered my case and gave concession.”

Another patient, Hussain said, “If health insurance companies could give cover the people similar to the government scheme, it could provide benefit to a number of people. I had an insurance policy but I got no benefit from the policy for the obesity surgery performed last year. So, paying premium didn’t help in my case.”

Recently, the state government entered into a tie-up with Bhandari group of hospitals in the city for such surgeries. The scheme for reimbursement of cost of surgery is operational for a year time and will be subjected to renewal.

Director of Bhandari group of hospitals Dr Mohit Bhandari said, “In foreign countries, body mass index (BMI) of 32.5 along with any one of the diseases including diabetes, hypertension, coronary heart disease, and arthritis and sleep syndrome makes a patient eligible for health insurance for bariatric surgery. Unfortunately, in India there is no such scheme. However, government initiative to reimburse the cost of surgery is significant and commendable.”

According to the Indian Council of Medical Research, Madhya Pradesh is ranked at 21 for obesity and diabetes in 2009 and improved its position at 8 in 2011. “Today people in the country suffer from obesity, diabetes, cancer and cardiac diseases. Government too considers obesity as a disease and is spending heavily for its research. So, it should be covered under health insurance policy,” said Dr Bhandari.

On the other hand, insurance companies consider obesity a lifestyle problem. Considering obesity as a cosmetic surgery, none of the insurance companies provide health cover. Pankaj Gupta, assistant branch manager with a health insurance company said, “None of the insurance companies cover obesity surgery as it is considered cosmetic surgery.”