Insurance firms don™t get to the fat of the matter

Dr Jayant Jadhav thought that he had won the battle when he underwent a life-saving bariatric surgery. For the 57-year-old orthopaedic surgeon, who weighed 98kg and suffered from uncontrolled diabetes and sleep apnoea, a gastric bypass surgery was the only way out of a possible development of retinopathy and nephropathy.

Within six months of undergoing the procedure, he lost 22kg, stopped taking insulin shots and began to sleep more peacefully.

But his battle was far from over. For over eight months now, he has been trying to get his medical insurance firm to pay up for the procedure. But the company has flatly refused. Reason: medical insurance firms consider weight loss surgery a cosmetic procedure and, therefore, do not cover it.

Dr Jadhav says before the surgery, he used to take 70 units of insulin daily, besides showing symptoms of eye and kidney ailments, and a sleep disorder. When his condition began to worsen, he approached Dr Sanjay Borude, a bariatric surgeon at Breach Candy Hospital.

Six months after a gastric bypass surgery, he found himself on the road to recovery. But the insurance firm rejected my claim, saying the surgery is not covered under its scheme. They believe this is a cosmetic surgery.” He now plans to approach the court.

Dr Jadhav is not alone. State-run JJ Hospital recently began to offer this surgery to obese patients with multiple health ailments. More than 35 surgeries were conducted here in the last 10 months.

Dr Shashank Shah, president of Obesity Surgery Society of India, says about 4,000 such surgeries have been conducted in Maharashtra over the last 10 years. We have written a letter to the Insurance Regulatory and Development Authority asking that the claims of such patients be passed.

In Dr Jadhav™s case, his doctor had even given a letter to the insurance company stating the medical reason behind his surgery.

Bariatric surgeon from Bombay Hospital Dr Raman Goel says the World Health Organisation defines obesity as a disease. Insurance companies just want to avoid claims and so, call it a cosmetic surgery. Only 10% of people who come to us for this surgery want to do it to look better.

http://www.dnaindia.com/mumbai/report_insurance-firms-dont-get-to-the-fat-of-the-matter_1794090