Do Medical Aids Cover Gastric Bypass Operations?
November 26, 2013
Obesity is a problem world-wide, not just in wealthier countries. Furthermore, obesity cases have doubled since 1980. The World Health Organisation has reported that over 2.8 million deaths around the world every year are a result of obesity. Therefore gastric bypass surgery is becoming more common.
In South Africa, as much as 61% of the population is overweight or obese. In addition, 78% of those people and 52% of morbidly obese sufferers think that they are of a normal weight.
When it comes to defining obesity, or being overweight, the reference is to a person with an abnormal or excessive accumulation of fat that can negatively impact their health.
Check Your BMI
Typically, a Body Mass Index (BMI) measures obesity. It’s not an entirely accurate measuring device but it uses a person’s height and weight to calculate an average weight range in adults. A person is overweight if their BMI is equal to or greater than 25. If their measurement is equal to or greater than 30, they are obese. A BMI over 40 is classified as morbidly obese. Obesity can also be measured by measuring the circumference of the waist.
Experts around the globe acknowledge that obesity is complicated in nature but they have identified a number of contributing factors such as people consuming more calories than they use. Furthermore, diets have changed and people are consuming diets high in fat and those that are energy-dense. We’re also leading more sedentary lifestyles since many jobs require us to sit and type as opposed to engaging in manual labor. Improved transport systems mean those that those who used to walk are no longer doing so.
A person that is obese is at greater risk of developing chronic diseases such as high blood pressure, Type 2 diabetes, asthma, cancer, high cholesterol and heart disease. Hence obesity is a major health problem.
Medical Aids Are Changing Their Tune
Historically many medial aids have considered weight loss surgery as a cosmetic procedure and have not covered the costs of gastric bypasses. But medical schemes in South Africa are starting to pay out for par or all of weight loss related surgery provided that the physician establishes that the operation is medically necessary to preserve the health of the patient.
Gastric bypass surgery is expense and so is bariatric surgery. If a medical aid does cover the surgery, they often don’t cover the cost of plastic surgery to remove excess skin after weight loss. Nor is the price for diet counseling and the necessary supplements included.
Gastric Bypass Surgery: Discovery Early
One of the first insurers to cover gastric bypass surgery was Discovery Health. But this is only available on the Executive and Comprehensive Plans and preauthorization was necessary. Bonitas medical aid covers the surgery too, provided that member is morbidly obese. You need preauthorization for this. Other schemes that do cover the surgery include Medshield, Metropolitan Health and Momentum Health. However, you should check with your specific medical aid provider.
One can ultimately prevent becoming overweight or obese but a complete lifestyle change is necessary and very challenging. Healthier food choices must be made and regular exercise is a necessity. When these measures aren’t enough then a person may require weight loss surgery to help them achieve a healthy weight.
All info was correct at time of publishing