Dr H V Shivaram, Head of the Dept.of Surgery& Allied Specialties,Program Director of Bariatric & Metaboilic Surgery, Aster CMI Hospital,Bengaluru • 30 years of experience in Surgical profession, Teaching, Training & Research. • Published articles in indexed Journals, conferences and authored chapters in surgical books. • Has served in Army Mecical corps(Captain) and was awarded Sainya Sewa Medal. “Doctor of the Year Award-2017” & “Rotary Gold medal Award in 1999” • Established Post graduate Surgery Training Program & Centres of Excellence in Bariatric & Metabolic Surgery at Aster CMI Hospital. Started Fellowship program in Bariatric & Metabolic surgery. Conducted many obesity awareness camps. • Trained surgeons across the country & from Ethhiopia in Laparoscopic Surgery • Visited Germany, USA, UK, France & other countries to deliver guest lectures • Member of various national & international professional bodies and executive committees both at National and State level

4. ➢ Long time to convince the authorities that obesity is a
disease and bariatric surgery is the most scientific method
to treat
➢ 27.09.2019 – IRDA – Bariatric Surgery to be covered by all
health insurance products
(Individual, family, group, corporate)
➢ Effective date: 01st October 2020

7. Who are eligible ?

8. OSSI Guidelines

9. How much amount ?

10. Is there any waiting period ?

12. Cashless Mode

13. Reimbursement Mode

14. Complications are covered ?

15. Revision Bariatric Surgery ?

16. Precautions to be taken by surgeons before sending the form
During first consultation find out whether pt. is claiming insurance
Document the history and examination carefully
BMI, Comorbidities – important
After documentation you can’t go back and overwrite/correct
If there are queries form TPA, send clarifications without delay

17. What are the most common reasons for rejections
✓ BMI
✓ Comorbidities
✓ Whether patient has failed with other methods
✓ Inadequate documentation

18. What to do if rejected ?
Patient should keep all the bills , correspondence
Apply for reimbursement
If rejected -- contact :
IRDAI
OSSI
Insurance Ombudsman
Consumer court