6 months ago
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A survey conducted by the Obesity and Metabolic Surgery Society of India (OSSI), a not-for-profit assemblage of bariatric and metabolic surgeons, has revealed important insurance-related hurdles that are preventing timely and life-saving attraction for patients surviving with terrible obesity.
Led by Dr. Aparna Govil Bhasker, Bariatric and Metabolic Surgeon astatine Saifee Hospital, Mumbai, on with elder surgeons from crossed the country, the probe highlights captious gaps successful entree to care. The Insurance Regulatory and Development Authority of India (IRDAI) mandated sum for metabolic and bariatric country successful 2019 erstwhile aesculapian criteria are met. However, the survey shows implementation remains inconsistent, creating barriers that hold treatment, worsen complications, and summation semipermanent healthcare costs.
The survey titled ‘The Surgeons’ Perspective On Insurance Coverage For Metabolic and Bariatric Surgery For India’ is published successful Obesity Surgery: The Journal Of Metabolic Surgery And Allied Care.
Rising obesity burden
India’s obesity prevalence is projected to triple by 2040. Doctors accent that obesity is not a manner flaw, but a chronic, progressive information linked to benignant 2 diabetes, hypertension, slumber apnoea, bosom disease, infertility, and definite cancers. Bariatric and metabolic surgery, which tin trim assemblage value by 30 to 40% and reverse galore associated illnesses, is among the astir effectual treatments. Yet, constricted security enactment leaves galore patients untreated oregon waiting for months.
Survey findings
The OSSI survey, conducted among 109 bariatric surgeons crossed aggregate states betwixt November 2024 and March 2025, paints a stark picture. 95.4% of surgeons reported patients delaying country portion awaiting security approval. Most surgeons (76.1%) said patients are unaware that security covers bariatric country adjacent erstwhile aesculapian criteria are met. The support process was rated analyzable by 69.7%, and 91.7% said it is much cumbersome than different regular surgeries. Nearly one-third reported denial rates of 50 to 75%, citing obesity exclusions, waiting periods, and documentation discrepancies. 81.7% noted important out-of-pocket costs contempt insurance.
Eligibility gaps
Surgeons powerfully supported lowering BMI thresholds and covering much comorbidities than presently listed nether IRDAI rules. While OSSI guidelines urge country for patients with BMI ≥35 kg/m² oregon >30 kg/m² with comorbidities, IRDAI restricts sum to BMI ≥40 kg/m² oregon ≥35 kg/m² lone with terrible comorbidities.
“Obesity is not a cosmetic issue; it is simply a chronic, progressive, and often disabling illness that affects each organ of the body,” Dr. Sumeet Shah, Secretary of OSSI, said.
Dr. Randeep Wadhawan, president of OSSI, added that the OSSI guidelines intelligibly authorities that bariatric, obesity, oregon weight-loss country should beryllium considered for eligible Indian patients with a BMI ≥ 35 kg/m² with oregon without associated diseases, and for patients with a BMI > 30 kg/m² erstwhile important comorbidities are present. However, the existent IRDAI security support criteria inactive restrict sum to patients with BMI ≥ 40 kg/m², oregon ≥ 35 kg/m² lone erstwhile terrible comorbidities are documented. “This creates a large spread betwixt evidence-based aesculapian guidelines and the security eligibility framework, yet limiting entree for patients who would payment astir from aboriginal surgical intervention,” helium said.
Impact connected patients
Delays person superior consequences, Dr. Manish Khaitan, erstwhile OSSI president, said. “Months are mislaid waiting for approvals, and during this play their metabolic, hormonal, and cardiovascular wellness often worsens. Bariatric and metabolic country is not cosmetic, it is simply a scientifically proven, disease-modifying attraction that prevents semipermanent complications. Insurance sum is not a privilege; it is simply a aesculapian necessity that saves lives.”
Dr. Aparna Govil Bhasker emphasized the spread betwixt argumentation and world and said that the survey shows that adjacent aft IRDAI’s mandate, the spread betwixt argumentation and world is precise wide. Patients look confusion, endless paperwork, repeated queries, and precocious out-of-pocket expenses. “As surgeons, we powerfully entreaty to security providers to recognize that obesity is simply a aesculapian illness and that attraction should beryllium easy accessible. Simplifying the process and widening eligibility criteria volition assistance thousands of individuals who are warring superior weight-related illnesses,” she said.
Dr. Surendra Ugale from Hyderabad urged insurers to enactment with clarity and compassion, “Lowering BMI thresholds successful accordance with OSSI guidelines, including obesity-related conditions similar benignant 2 diabetes, and reducing unnecessary documentation tin marque a immense difference. Early entree to bariatric and metabolic country not lone improves diligent wellness but besides reduces semipermanent healthcare costs for families and insurers.”
Despite aesculapian advancement and IRDAI guidelines, the deficiency of creaseless and accordant sum remains a large obstacle. “Addressing these gaps done simpler approvals, wider eligibility, and stronger consciousness tin amended entree to life-saving attraction and fortify India’s nationalist wellness landscape,” Dr. Wadhawan said.
