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Big, fat, and insured: Insurance to provide cover for bariatric surgery

Monday, 30 June 2014 - 9:45am IST | Agency: dna
32-yr-old Ghatkopar resident convinces insurer to provide cover for bariatric surgery

Shed flab, stay slim, and get cover.

For many bariatric patients, Ghatkopar resident Raksha Gawde (name changed) means Lady Luck. When the 32-year-old underwent a bariatric surgery recently, it ended many of her ailments. When her insurance claim of Rs 1.8 lakh was cleared, it ended an ongoing debate between doctors and insurers.

Insurance companies, generally, skip cover for bariatric surgery, arguing it's a cosmetic procedure and not a medical condition.

What clinched the deal in favour of Gawde is that she and her husband were able to convince ICICI Prudential Life that the surgery was a life-saving one and not one done for better looks.

"My wife suffered from many health ailments. So, we decided to opt for this surgical procedure. We provided all documents and they finally passed the claim of Rs 1.8 lakh," he said.

Gawde, who weighed 89 kg, was suffering from obesity-related ailments like back pain, lethargy, tiredness and breathlessness on walking and climbing. In February, she underwent a sleeve gastrectomy surgery.

Dr Jayshri Todkar, the first woman bariatric surgeon in country and Joint Secretary of Obesity Surgery Society of India (OBSSI), who operated on Gawde at Dr L H Hiranandani Hospital, says: "About 8-10% of Mumbai population suffers from obesity-related health ailments. This is really a great move by the company. Companies are always in denial mode on obesity surgeries."

"Weight-loss surgery not only reduces weight but cure patients of diseases like obstructive sleep apnea, fatty liver, diabetes and thick veins," she said.
About 5,000 bariatric surgeries have been conducted in Maharashtra in the last 10 years. The International Federation for Surgery of Obesity & Metabolic Disorder (IFSO) data shows that around 14,000 people undergo weight-loss surgery in the country every year.

Obesity-related conditions, including heart disease, stroke, type 2 diabetes and certain cancers are some of the leading causes of preventable death.

Insurance expert Sanjay Datta said, "If obesity is life-threatening, companies contemplate passing claims. But it will depend on a case-to-case basis and has to be rightly substantiated by doctors. Companies provide insurance to obesity surgery if proved it's being done for serious health ailments."

Dr Sanjay Borude, bariatric surgeon, Breach Candy hospital, said, "People come to us for bariatric surgery to get freedom from illness. They don't come to us for looking good. It's high time insurance companies recognised it as a disease and extend cover to obesity surgery. So far, claims of 80 of my patients have been rejected."

What is sleeve gastrectomy?
Sleeve gastrectomy is a restrictive form of weight-loss surgery in which approximately 85% of the stomach is removed, leaving a cylindrical or sleeve-shaped stomach. The removal of the major part of the stomach results in the virtual elimination of ghrelin hormones, which stimulate hunger. It gives the feeling of instant fullness after a light meal.

e claim. The same thing to do with breast reduction procedure if the orthopaedic surgeon says patient got pain in neck due to breast size and its need reduction in such case Insurance company pass the claim.
 




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