Insurance Delays and Access to Bariatric Surgery

Why in News?

Recently, a survey conducted by the Obesity and Metabolic Surgery Society of India (OSSI, has revealed significant insurance-related hurdles that are preventing timely and life-saving care for patients living with severe obesity.

What is the study?

• Conducted by – Obesity and Metabolic Surgery Society of India (OSSI).
• OSSI – It is a not-for-profit body of bariatric and metabolic surgeons
• OSSI survey highlights approval delays, IRDAI coverage gaps and bariatric surgery insurance hurdles.
• Title – The study titled ‘The Surgeons’ Perspective on Insurance Coverage for Metabolic and Bariatric Surgery for India’ is published in Obesity Surgery: The Journal of Metabolic Surgery and Allied Care.
• IRDAI mandate – The Insurance Regulatory and Development Authority of India (IRDAI) mandated coverage for metabolic and bariatric surgery in 2019 when medical criteria are met.
• The OSSI survey, conducted among 109 bariatric surgeons across multiple states between November 2024 and March 2025, paints a stark picture.

What are the Survey findings?

• Criticality of obesity – Doctors stress that obesity is not a lifestyle flaw, but a chronic, progressive condition linked to type 2 diabetes, hypertension, sleep apnoea, heart disease, infertility, and certain cancers.
• Bariatric and metabolic surgery – It can reduce body weight by 30 to 40% and reverse many associated illnesses, is among the most effective treatments.
• Yet, limited insurance support leaves many patients untreated or waiting for months.
• Delayed insurance approval – 95.4% of surgeons reported patients delaying surgery while awaiting insurance approval.
• Lack of awareness – Most surgeons (76.1%) said patients are unaware that insurance covers bariatric surgery even when medical criteria are met.
• Complex approval process – The approval process was rated complex by 69.7%, and 91.7% said it is more cumbersome than other routine surgeries.
• Large denial rate – Nearly one-third reported denial rates of 50 to 75%, citing obesity exclusions, waiting periods, and documentation discrepancies.
• Increasing expenditure of people – 81.7% noted significant out-of-pocket costs despite insurance.
• Implementation barriers – The survey shows implementation remains inconsistent, creating barriers that delay treatment, worsen complications, and increase long-term healthcare costs.
• Rising obesity burden – India’s obesity prevalence is projected to triple by 2040.  

What are the measures suggested?

• Lowering BMI threshold – Surgeons strongly supported lowering BMI thresholds and covering more comorbidities than currently listed under IRDAI rules.
  • OSSI guidelines recommend surgery for patients with BMI ≥35 kg/m² or >30 kg/m² with comorbidities.
  • IRDAI restricts coverage to BMI ≥40 kg/m² or ≥35 kg/m² only with severe comorbidities.
• Improving accessibility – Insurance providers should understand that obesity is a medical disease and that treatment should be easily accessible.
• Process simplification – Simplifying the process and widening eligibility criteria will help thousands of individuals who are fighting serious weight-related illnesses.
• Other measures – Insurers should act with clarity and compassion,
  • Including obesity-related conditions like type 2 diabetes,
  • Reducing unnecessary documentation can make a huge difference.

What lies ahead?

• Bariatric and metabolic surgery is not cosmetic, it is a scientifically proven, disease-modifying treatment that prevents long-term complications.
• Insurance coverage is not a privilege, it is a medical necessity that saves lives.
• Addressing these gaps through simpler approvals, wider eligibility, and stronger awareness can improve access to life-saving treatment and strengthen India’s public health landscape.
• Early access to bariatric and metabolic surgery not only improves patient health but also reduces long-term healthcare costs for families and insurers.

Reference

The Hindu| Insurance Delays and Access to Bariatric Surgery