Insurance firms now paying for bariatric surgery for diabetes

Mumbai: After years of looking at bariatric surgery as a cosmetic weight-loss procedure, Indian medical insurance companies seem to have changed their minds. They have begun reimbursing some patients who have undergone bariatric surgery — now classified as a metabolic operation that involves cutting or bypassing parts of the stomach and intestine — to control or even get rid of their diabetes. 

    K Satishan (name changed), a 62-year-old businessman from Pune who was a diabetic patient for 15 years, got Rs 5 lakh reimbursement from Bajaj Allianz after he and his doctors explained that the surgery was literally his last option. “I was on high doses of insulin and oral medication and yet my sugar levels were four times the normal one,” said Satishan. 
    While bariatric surgeries essentially lead to weight loss, a welcome side-effect has been the control of diabetes and hypertension. 
    These surgeries were initially recommended for morbidly obese people, but in the last five years, they are being offered to diabetic patients who are not obese. 
    “Satishan was weighing 90-odd kilos. His weight was not as much a problem as his diabetes and hypertension were,’’ said Dr Shashank Shah, the metabolic surgeon from Pune who operated on the businessman. 
OPERATION SUCCESSFUL 

• There are 60 million people with diabetes in India 

• Bariatric or metabolic surgery is considered appropriate treatment for people suffering from type 2 diabetes and obesity 

• The surgery involves cutting or bypassing a portion of the stomach 

• Doctors say it triggers hormonal changes, makes the intestine work harder and faster, leading to reduction of weight and blood sugar ‘Payout on case-to-case basis for op’ 
    Another of Shah’s patients, Somnath Holkar, got reimbursed from United IndiaInsurance after six months of explanations. “I underwent the operation seven months ago and got the reimbursement last month,” he said. 
    Satishan recalled how he took his blood sugar and pressure readings every day and showed the three-month chart to the insurance company. “I don’t take any diabetic pills now. The company even interviewed my doctor before agreeing,” he said. He was operated in May 2013 and got his reimbursement recently. 
    Incidentally, the Central Government Health Scheme (CGHS) in December declared that it would fund bariatric surgeries for current and former government employees. Dr Ramen Goel, a metabolic surgeon from Mumbai, said if CGHS can fund surgeries for its employees, insurance companies should take the cue. 
    Sanjay Datta from ICICI Lombard said medical insurance companies have begun reimbursing bariatric and metabolic surgeries on a case-tocase basis. Metabolic surgery for diabetes is still in the trial stage, with many medical associations admitting that longterm studies are needed before accepting surgery as a cure for diabetes. Hence, many patients who have undergone metabolic surgeries in the last five years have got reimbursements only after moving consumer courts. “Many of my patients moved the consumer courts to get insurance reimbursement,” said Goel. 
    Doctors hope insurance payoffs will become the trend, especially because India has over 60 million diabetes patients. Shah, who has operated on 800 patients for diabetes, said many of them are now approaching insurance companies. “A patient who is scheduled to undergo surgery in Fortis Hospital in Mulund is awaiting hisinsurance company’s decision,” he added. 
DOC’S ADVICE 
    The International Diabetic Federation (IDF) says surgery can be offered for people with a body mass index of 35 kg/m2 or more 
    Among Asians, especially Indians, BMI points may be reduced by 2.5 kg/m2 
    IDF says surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 kg/m2 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors

'If insurance policy is unclear, benefit must go to consumer'

Chennai: If there is any ambiguity in the terms of an insurance policy, the benefit should go to the consumer, a consumer forum here has ruled, asking aninsurance company to pay the entire medical claim amount to a man who underwent a surgery. 

    Manicklal Rathi, 69, took a mediclaim policy from National Insurance Company Ltd at an annual premium of Rs 28,000 under which he was covered up to a medical expenditure of Rs 4 lakh. Rathi, who had a policy for Rs 2 lakh since 2000, enhanced the cover to Rs 4 lakh in February 2010. Two months later, he underwent a knee replacement surgery, incurring an expenditure of Rs 2.69 lakh. 
    However, the company did not settle the full amount and withheld Rs 79,131. The company did not respond to his representations, prompting him to approach the Consumer Protection Council, Tamil Nadu, which filed a complaint on his behalf at the district consumer disputes redressal forum, Chennai (North). 
    In its reply, the company said that according to the terms of the policy, it could not reimburse the entire amount during the initial four years of the policy period. Further, it argued, Rathi had “already submitted a discharge voucher” for the sum he received and hence cannot stake claim for more. 
    Quashing the company’s arguments as “unsustainable” recently, the bench comprising president R Mohandoss and member T Kalaiyarasi found it guilty of negligence and deficiency in services. It directed the company to reimburse Rs 79,131 along with an interest of 9%. The forum also slapped a fine of Rs 5,000 on the company for deficiency in services and awarded Rathi another Rs 2,000 as case costs.

Insurance firms now paying for bariatric surgery for diabetes

Mumbai: After years of looking at bariatric surgery as a cosmetic weight-loss procedure, Indian medical insurance companies seem to have changed their minds. They have begun reimbursing some patients who have undergone bariatric surgery — now classified as a metabolic operation that involves cutting or bypassing parts of the stomach and intestine — to control or even get rid of their diabetes.      K Satishan (name changed), a 62-year-old businessman from Pune who was a diabetic patient for 15 years, got Rs 5 lakh reimbursement from Bajaj Allianz after he and his doctors explained that the surgery was literally his last option. “I was on high doses of insulin and oral medication and yet my sugar levels were four times the normal one,” said Satishan.      While bariatric surgeries essentially lead to weight loss, a welcome side-effect has been the control of diabetes and hypertension.      These surgeries were initially recommended for morbidly obese people, but in the last five years, they are being offered to diabetic patients who are not obese.      “Satishan was weighing 90-odd kilos. His weight was not as much a problem as his diabetes and hypertension were,’’ said Dr Shashank Shah, the metabolic surgeon from Pune who operated on the businessman.  OPERATION SUCCESSFUL  • There are 60 million people with diabetes in India  • Bariatric or metabolic surgery is considered appropriate treatment for people suffering from type 2 diabetes and obesity  • The surgery involves cutting or bypassing a portion of the stomach  • Doctors say it triggers hormonal changes, makes the intestine work harder and faster, leading to reduction of weight and blood sugar ‘Payout on case-to-case basis for op’      Another of Shah’s patients, Somnath Holkar, got reimbursed from United IndiaInsurance after six months of explanations. “I underwent the operation seven months ago and got the reimbursement last month,” he said.      Satishan recalled how he took his blood sugar and pressure readings every day and showed the three-month chart to the insurance company. “I don’t take any diabetic pills now. The company even interviewed my doctor before agreeing,” he said. He was operated in May 2013 and got his reimbursement recently.      Incidentally, the Central Government Health Scheme (CGHS) in December declared that it would fund bariatric surgeries for current and former government employees. Dr Ramen Goel, a metabolic surgeon from Mumbai, said if CGHS can fund surgeries for its employees, insurance companies should take the cue.      Sanjay Datta from ICICI Lombard said medical insurance companies have begun reimbursing bariatric and metabolic surgeries on a case-tocase basis. Metabolic surgery for diabetes is still in the trial stage, with many medical associations admitting that longterm studies are needed before accepting surgery as a cure for diabetes. Hence, many patients who have undergone metabolic surgeries in the last five years have got reimbursements only after moving consumer courts. “Many of my patients moved the consumer courts to get insurance reimbursement,” said Goel.      Doctors hope insurance payoffs will become the trend, especially because India has over 60 million diabetes patients. Shah, who has operated on 800 patients for diabetes, said many of them are now approaching insurance companies. “A patient who is scheduled to undergo surgery in Fortis Hospital in Mulund is awaiting hisinsurance company’s decision,” he added.  DOC’S ADVICE      The International Diabetic Federation (IDF) says surgery can be offered for people with a body mass index of 35 kg/m2 or more      Among Asians, especially Indians, BMI points may be reduced by 2.5 kg/m2      IDF says surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 kg/m2 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors

Buying a back-dated insurance policy? While it's legal to purchase an insurance policy with a back date, remember that it may not always be beneficial for the buyer

Wouldn’t it be great if you could turn the clock back? You could make a lot of money by investing in the right stocks. While you can’t go back in time when it comes to stock investments, you can buy certain lifeinsurance policies with a back date. Back-dating of a life insurance policy is a perfectly legal and standard practice in the insurance industry. So, the new plans launched by insurance companies in the past 1-2 months can be bought with any date in the financial year starting 1 April 2013.  Is back-dating useful?  Back-dating is useful in certain situations. A life insurance policy is not the best way to save tax and there are better, more flexible and lucrative options to do so. Even so, millions of taxpayers buy life insurance to save tax. If a taxpayer needs to exhaust his Section 80C limit through a life insurance policy this year but wants to pay the premium on a monthly or quarterly basis from next year, he will find back-dating useful. He can pay the premiums for this year at one go, and from next year, he can pay them whenever they are due.      It is also useful in case the buyer has just crossed the minimum age for buying a certain policy.      There are also sentimental reasons for back-dating. Sometimes, buyers want their insurance policies to be issued on an important date during the year. It could be a birthday, wedding anniversary or any other date with emotional value. This also ensures that the maturity of the policy coincides with that important date. It also sets a reminder for the premium.  Look before you leap  Going back in time also reduces the waiting period for the policyholder. If you buy a money-back policy in March 2014, you will get the first tranche (which is 20% of the sum assured) after five years in 2019. However, if you back-date the policy to April 2013, you will get the money in four years and one month, in April 2018.      Before you are led into believing that this is a great way to get your money back faster, do the math. The next premium becomes due in a month in April 2014. Also, you are charged a 10% interest on the premium you pay for the back-dated policy. “It makes little sense to pay 10% interest on a policy that earns you only 6-7%,” says a Delhi-based insurance expert.      If the back date is more than one month away, the buyer is charged a 10% annual interest on a pro-rata basis. So, if you want to back-date a policy by three months, be ready to pay an interest of 2.5%. The Anand Money Back package, a combo of two money-back plans and an endowment policy, being hawked by LIC agents, has one plan dating back to April 2013. The premium will be due next month.      Incidentally, the interest on the back-dating kicks in only after 30 September. Till this cut-off date, the LIC does not charge any interest even if the policy is back-dated by 5-6 months. There is also no charge if the back-dating is for less than a month.  Zero sum game  Insurance agents use back-dating to lure buyers. Insurance companies base their premiums on the policyholder’s age. LIC, for instance, goes by the last birthday of the buyer. If the policy dates back to before your birthday, the premium will be lower. However, this is a zero sum game. In your quest for a lower premium rate, you will end up paying extra premium. This is why back-dating works only in endowment and money-back plans. Back-dating a term plan is an exercise in futility because the coverage for the entire back-dated period effectively goes waste.