Surgeons’ Perspectives on Insurance Coverage for Metabolic and Bariatric Surgery in India: An Obesity and Metabolic Surgery Society of India (OSSI) Survey

Abstract

Background: Metabolic and bariatric surgery (MBS) is a proven and effective treatment for obesity and its related illnesses. In 2019, the Insurance Regulatory and Development Authority of India (IRDAI) mandated that MBS be covered under health insurance policies if specific medical criteria are met. However, real-world implementation of this policy is often inconsistent, with reports of claim denials and delays. This study aimed to assess Indian metabolic and bariatric surgeons’ experiences with insurance coverage for metabolic and bariatric surgery. Methods: A cross-sectional survey was conducted among 109 members of the Obesity Surgery Society of India (OSSI) using a structured Google Form between November 2024 and March 2025. The questionnaire covered surgeon demographics, insurance experiences, patient patterns, and policy suggestions. Data were collected anonymously and analyzed using descriptive statistics. Results: While 87.2% of respondents observed more patient interest after IRDAI’s insurance mandate, only 9.2% reported that most of their patients used insurance. Low awareness, complex paperwork, and high out-of-pocket costs were major problems. 95.4% said patients delay surgery while waiting for insurance approval. The approval process was rated as complex or very complex by 69.7%. High denial rates were reported, often due to obesity exclusions or incomplete documentation. Nearly all respondents supported changes to improve the system, including faster approvals, fewer documentation requirements, and broader eligibility criteria such as lower BMI thresholds and inclusion of type 2 diabetes. Conclusions: Despite regulatory progress, insurance-related challenges like administrative delays, poor patient awareness, and inconsistent claim approvals continue to limit equitable access to MBS in India. Policymakers and insurers need to streamline processes and expand eligibility to ensure more people can benefit from this life-saving treatment.