Overview
- OSSI surveyed 109 bariatric surgeons across multiple states (Nov 2024–Mar 2025) and 95.4% said patients delayed surgery while awaiting insurance approval.
- Most respondents rated approvals difficult, with 69.7% calling the process complex, 91.7% saying it is more cumbersome than other surgeries, and nearly one-third reporting 50–75% denial rates tied to exclusions, waiting periods, and documentation issues.
- Surgeons reported low patient awareness of coverage (76.1%) and significant out-of-pocket expenses despite insurance (81.7%), contributing to underutilisation of benefits.
- A policy-practice gap persists as OSSI guidelines support surgery at BMI ≥35 kg/m² or >30 kg/m² with comorbidities, while IRDAI-linked eligibility typically requires BMI ≥40 kg/m² or ≥35 kg/m² with severe comorbidities.
- OSSI leaders are urging insurers to streamline paperwork, speed approvals, and widen eligibility to improve access, prevent worsening comorbidities, and lower long-term healthcare costs.