Insurance hurdles preventing timely care for patients with obesity: OSSI survey

Mumbai: A new national survey conducted by the Obesity and Metabolic Surgery Society of India (OSSI) has revealed significant insurance related hurdles that are preventing timely and life-saving care for patients living with severe obesity.

Led by Dr Aparna Govil Bhasker, Bariatric and Metabolic Surgeon at Saifee Hospital, Mumbai, along with senior surgeons from across the country, the research highlights critical gaps in access to care.

The Insurance Regulatory and Development Authority of India (IRDAI) mandated coverage for metabolic and bariatric surgery in 2019 when medical criteria are met. However, the survey reveals that implementation remains inconsistent.

These gaps in execution create multiple barriers for patients — delaying treatment, increasing complications, worsening long-term health outcomes. This has a major adverse impact on long term health care costs related to chronic disease management.

The OSSI represents bariatric and metabolic surgeons nationwide and is committed to advancing safe, evidence-based, and accessible care for obesity and metabolic diseases.

“Those recommended for metabolic surgery should proceed without delay, as postponing treatment only worsens obesity-related diseases. Early treatment supports faster recovery, better health outcomes,” said Dr. Randeep Wadhawan, President, OSSI, said in a statement.

The Surgeons’ Perspective On Insurance Coverage For Metabolic and Bariatric Surgery For India: An Obesity and Metabolic Surgery Society of India (OSSI) is published in Obesity Surgery: The Journal Of Metabolic Surgery And Allied Care (https://link.springer.com/article/10.1007/s11695-025-08324-3).

Key findings from the OSSI survey revealed that 95.4% of surgeons report patients delaying bariatric and metabolic surgery while awaiting insurance approval. Most surgeons (76.1%) said patients are unaware that insurance covers bariatric surgery even when medical criteria are met, and actual utilization remains low.

The approval process was largely viewed as difficult, with 69.7% rating it complex and 91.7% stating it is more cumbersome than approvals for other routine surgeries. High denial rates were noted, with nearly one-third of the surgeons reporting 50–75% rejections. Common reasons for rejection were- obesity exclusions, waiting period issues, or documentation discrepancies. 81.7% of surgeons reported significant out-of-pocket costs despite insurance.

Obesity problem in India

India is witnessing an alarming rise in obesity and the overall prevalence is set to triple in numbers by the year 2040. Obesity affects millions of people from younger to older age groups. Doctors stress that it is not a lifestyle flaw but a complex, chronic, progressive and relapsing medical condition that leads to type 2 diabetes, hypertension, sleep apnea, heart disease, joint problems, infertility, and increases the risk of certain cancers. Bariatric and metabolic surgery is one of the most effective treatment options for severe obesity that can lead to total body weight loss of 30 to 40% and reverse many of the associated illnesses. It can help patients regain health, mobility, and improve their quality of life. However, limited insurance support continues to leave many patients untreated or delays their care for months or years.