In a first, diabetic woman gets weight-loss surgery reimbursed

A leading insurance company last month accepted a claim for a weight loss surgery and reimbursed the patient with about Rs 1.20 lakh. Priyanka Vora reports.

A leading insurance company last month accepted a claim for a weight loss surgery and reimbursed the patient with about Rs 1.20 lakh.

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Weighing 130 kilos, Rashida, 48, (name changed) who was suffering from hypertension and diabetes underwent a gastric bypass surgery at Aastha Health Care, Mulund in July. Tasneem, Rashida's daughter, who worked in a corporate house, had health insurance coverage of Rs 1.5 lakh, which even insured her mother.

"Prior to the surgery, I had taken approval from the company's human resource department for the surgery. Though the doctor said that insurance companies do not cover weight loss surgery, I was determined to claim it as the surgery was not for cosmetic reasons," said Tasneem. "My mother was insulin dependent and no other treatment had helped her," she said.

In September, the insurance company rejected the claim stating that weight loss surgeries are not covered under health insurance. However after pursuing the matter for 3 months the Bajaj Allianz General Insurance for 3 months, Tasneem got her claim of Rs 1.20 lakh reimbursed.

"I have operated more than 1800 cases and so far not a single patient has been able to get his surgery covered under health insurance. In our hospital, a team of 3 specialty doctors certify that the patient requires the surgery for medical reasons," said Dr Manish Motwani, laparoscopic weight loss surgeon, Aastha Health Care, Mulund.

"The woman was suffering from grade III obesity which led to other complications such as diabetes, hypertension, piles. It is very rare for Wight loss surgery to be covered under insurance. Initially we had rejected, as there was no information on the medical reasons for the surgery. As her symptoms were very severe and surgery was the only way, her case was accepted," said, Dr Renuka Kanvinde, Senior Manager, Health Administration, Bajaj Allianz General Insurance.