Insurance Delays Keep Bariatric Patients Waiting Despite Coverage Rule

Many people in Maharashtra who qualify for bariatric or metabolic surgery are still unable to undergo the procedure because their insurance approvals simply don’t come through in time, according to a recent report by The Hindu. This is happening even though the surgery has been eligible for health insurance coverage for several years.

A Rule That Hasn’t Reached Patients

When the Insurance Regulatory and Development Authority of India (Irdai) instructed insurers in 2019 to include bariatric surgery under standard health policies, the directive was expected to ease a major financial burden. For patients living with severe obesity and related illnesses such as diabetes or hypertension, the surgery often marks a turning point in long-term health.

But hospitals quoted in the report say the promise of coverage has remained mostly on paper. Many patients are stuck waiting for insurers to send pre-authorisation approvals, a process that should ideally take days but often stretches for weeks. Doctors describe instances where all medical assessments are complete and operating teams are ready — yet the case cannot move forward because the insurer has not confirmed whether it will pay.

The Pressure Builds As Illness Progresses

The delays are not just administrative irritants; they have medical consequences. Specialists interviewed in the report point out that obesity-related conditions tend to worsen quickly. A postponed surgery can lead to uncontrolled diabetes, increased blood pressure, or mobility issues, making the eventual procedure riskier and recovery longer.

Some patients try to hold out, hoping the insurer will respond. Others end up dipping into savings or taking loans to go ahead with the surgery. And then some simply withdraw, deciding they cannot afford the uncertainty, even if their health is deteriorating.

Hospitals say much of the waiting stems from repeated demands for documents. Patients are asked to resubmit test results, produce years-old medical files, or get additional notes from specialists, even when the original paperwork is complete. Each additional round of queries pushes the surgery further into the future.

Hospitals Shoulder The Administrative Load

Medical teams are also feeling the strain. Since no procedure can be scheduled without insurance approval, surgeons and coordinators must rearrange calendars at the last minute. Administrators spend hours following up with insurance desks, often without getting a firm answer.

Doctors say a deeper issue lies in how some insurers interpret eligibility. Even cases that meet clinical guidelines are sometimes labelled “non-essential” or pushed aside for further review. This mismatch between policy intent and insurer practice has left hospitals caught between medical urgency and bureaucratic hesitation.

What Needs To Happen Next

For the coverage mandate to truly work, insurers will need to make approval processes simpler and far more predictable. Clear communication, shorter turnaround times, and a more consistent interpretation of Irdai’s rules would help both hospitals and patients.

The report also notes a need for better awareness. Many policyholders do not realise they are entitled to coverage for bariatric surgery, and this lack of information prevents them from even beginning the claims journey.

Until these gaps close, patients who urgently require metabolic or bariatric surgery will continue to face avoidable delays, and the promise of accessible care will remain only partially fulfilled.