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