A new national survey by the Obesity and Metabolic Surgery Society of India (OSSI) highlights significant insurance-related barriers affecting timely access to bariatric and metabolic surgery. Although 87.2% of surgeons observed increased patient interest after the 2019 IRDAI mandate, most reported under-utilization of insurance due to low awareness, high out-of-pocket expenses, and cumbersome processes. Furthermore, 95.4% of surgeons confirmed that patients often delay treatment while awaiting approvals, underscoring the widespread challenges in accessing covered care.
Survey Overview and Methodology
As per the press release, the study, titled The Surgeons’ Perspective on Insurance Coverage for Metabolic and Bariatric Surgery in India, appears in Obesity Surgery: The Journal of Metabolic Surgery and Allied Care. Led by Dr. Aparna Govil Bhasker and supported by senior surgeons nationwide, the survey assessed insurance-related hurdles across India. Researchers collected data from 109 bariatric surgeons between November 2024 and March 2025 using a structured, anonymous questionnaire. The questions explored surgeon demographics, patient behaviour, approval delays, denial reasons, and policy-level suggestions.
Key Insurance Challenges Identified
The findings reveal deep gaps between IRDAI’s coverage mandate and real-world implementation. Most surgeons (76.1%) noted that patients remain unaware that insurance covers bariatric surgery when criteria are met. Nearly 70% rated the approval process as complex, while 91.7% said it is more cumbersome than approvals for routine surgeries. Denial rates remain high, with about one-third of surgeons reporting 50–75% rejections for reasons such as obesity exclusions, long waiting periods, and documentation mismatches. Consequently, 81.7% of surgeons reported significant out-of-pocket costs despite nominal coverage.
Growing Need Amid India’s Obesity Crisis
India faces an escalating obesity burden, with prevalence expected to triple by 2040. Experts emphasize that obesity is not a lifestyle flaw but a chronic, progressive condition linked to diabetes, hypertension, sleep apnea, cardiovascular disease, infertility, joint problems, and several cancers. Bariatric and metabolic surgery remains one of the most effective treatments, delivering 30–40% total body weight loss and reversing many obesity-related illnesses. Yet insurance barriers continue to delay or prevent lifesaving interventions.
Mismatch Between Medical Guidelines and Insurance Criteria
Surgeons strongly advocated expanding eligibility for insurance coverage. While OSSI guidelines recommend surgery for patients with BMI ≥ 35 kg/m²—with or without comorbidities—and for those with BMI > 30 kg/m² with significant comorbidities, current IRDAI criteria remain restrictive. IRDAI covers only patients with BMI ≥ 40 kg/m², or ≥ 35 kg/m² with severe comorbidities. This gap limits access for patients who could benefit from earlier intervention.
Expert Appeals for Policy Reform
OSSI leaders urged policymakers and insurers to streamline processes, reduce documentation burdens, and align approval criteria with current medical evidence. Dr. Sumeet Shah emphasized that obesity is a serious disease affecting multiple organs, while Dr. Manish Khaitan underscored the dangers of delayed treatment, which worsens metabolic and cardiovascular health.
Dr. Aparna Govil Bhasker highlighted persistent gaps between policy and practice, noting that patients face confusion, repeated queries, and long delays despite IRDAI guidelines. Similarly, Dr. Surendra Ugale called for lower BMI thresholds, inclusion of more obesity-related conditions like type 2 diabetes, and simpler documentation to reduce long-term healthcare costs.
Call for Immediate Action
Nearly all surgeons surveyed (99.1%) agreed that insurance processes must be urgently streamlined. Improving transparency, accelerating approvals, and strengthening awareness can significantly enhance access to obesity treatment. As Dr. Randeep Wadhawan summarized, addressing these barriers will allow patients to receive timely care, improve public health outcomes, and reduce the long-term economic burden of chronic diseases.