Insurance delays block access to bariatric surgery despite IRDAI mandate

By Admin

27 Nov, 2025

India is witnessing a growing health crisis as more people struggle with severe obesity and related illnesses. Despite the Insurance Regulatory and Development Authority of India (IRDAI) mandating coverage for bariatric and metabolic surgery in 2019, countless patients still face delays and denials. A recent nationwide survey by the Obesity and Metabolic Surgery Society of India (OSSI) exposes deep systemic gaps that continue to restrict timely access to life-saving treatment.

OSSI Survey Exposes Troubling Insurance Barriers

The survey, conducted by OSSI India’s leading not-for-profit body of bariatric and metabolic surgeons highlights the persistent insurance hurdles faced by patients in need. Led by Dr. Aparna Govil Bhasker of Saifee Hospital, Mumbai, and senior surgeons from across India, the study titled “The Surgeons’ Perspective on Insurance Coverage for Metabolic and Bariatric Surgery for India” has been published in Obesity Surgery: The Journal of Metabolic Surgery and Allied Care.

Despite IRDAI’s mandate, the survey reveals that implementation is inconsistent, slow, and riddled with restrictive eligibility criteria. These barriers delay treatment, worsen complications, and increase long-term healthcare costs ultimately putting lives at risk.

India’s Rising Obesity Burden

India’s obesity prevalence is projected to triple by 2040. Experts emphasize that obesity is not a cosmetic flaw but a chronic, progressive disease linked to type 2 diabetes, hypertension, sleep apnoea, heart disease, infertility, and even certain cancers. Bariatric and metabolic surgery capable of reducing 30–40% of body weight and reversing many comorbidities is among the most effective treatments available.

But because of limited insurance support, countless patients remain untreated or wait months for approvals.

Key Findings From the OSSI Survey

The OSSI survey, conducted among 109 bariatric surgeons across multiple states between November 2024 and March 2025, paints a stark and worrying picture:

• 95.4% of surgeons said patients delayed surgery while awaiting insurance approval.
• 76.1% reported that patients were unaware that bariatric surgery is covered under insurance when medical criteria are met.
• 69.7% found the approval process complex, while 91.7% said it is more cumbersome than for other routine surgeries.
• Nearly one-third of respondents reported denial rates of 50–75%, often due to obesity exclusions, waiting periods, and documentation discrepancies.
• 81.7% noted that patients incur significant out-of-pocket expenses despite having insurance.

These findings highlight how bureaucratic hurdles are preventing vulnerable patients from receiving critical care.

Eligibility Gaps: Medical Guidelines vs. Insurance Rules

A major area of concern is the mismatch between OSSI’s medical guidelines and IRDAI’s insurance eligibility criteria.

OSSI recommends surgery for:
• Patients with BMI ≥ 35 kg/m² (with or without associated diseases)
• Patients with BMI > 30 kg/m² with significant comorbidities

However, IRDAI restricts coverage to:
• BMI ≥ 40 kg/m², or
• BMI ≥ 35 kg/m² only with severe comorbidities

This leaves a large population of medically eligible patients uncovered.

“Obesity is not a cosmetic issue; it is a chronic, progressive, and often disabling disease that affects every organ of the body,” said Dr. Sumeet Shah, Secretary of OSSI.

OSSI President Dr. Randeep Wadhawan stressed that current insurance rules lag far behind evidence-based guidelines. He added that this gap “ultimately limits access for patients who would benefit most from early surgical intervention.”

Impact on Patients: Health Deteriorates While Waiting

The consequences of these delays are severe and well-documented.

“Months are lost waiting for approvals, and during this period their metabolic, hormonal, and cardiovascular health often worsens,” noted Dr. Manish Khaitan, former OSSI president. “Bariatric and metabolic surgery is not cosmetic; it is a scientifically proven, disease-modifying treatment.” He emphasized that insurance coverage must be seen as a medical necessity, not a luxury.

Dr. Aparna Govil Bhasker further highlighted the wide gap between policy and ground reality. Patients often face endless paperwork, repeated queries, confusion, and high out-of-pocket costs. “As surgeons, we strongly appeal to insurance providers to understand that obesity is a medical disease and treatment should be easily accessible,” she said.

Call for Reform: Clarity, Compassion, and Practical Support

From Hyderabad, Dr. Surendra Ugale emphasized the need for insurers to act with “clarity and compassion.” He urged them to lower BMI thresholds in line with OSSI guidelines, include common obesity-related conditions like type 2 diabetes, and simplify documentation requirements.

Early surgery not only improves patient health but significantly reduces long-term healthcare costs benefiting patients, families, and insurers alike.

Bridging the Gap for Better Public Health

Despite modern medical advancements and IRDAI’s guidelines, inconsistent implementation continues to be a major obstacle. Strengthening awareness, widening eligibility, and simplifying approvals can dramatically improve access to life-saving bariatric and metabolic surgery.

As Dr. Wadhawan concluded, addressing these systemic gaps is essential to improving patient outcomes and strengthening India’s public health landscape.