Plan of Health Covers Bariatric Surgery

Health Insurance Covers Bariatric Surgery

One of the procedures that raises the most questions about whether health insurance covers it is bariatric surgery. However, according to the World Health Organization (WHO), obesity is a health problem that affects the vast majority of the population.

In Brazil, around 50% of adults and 15% of children are overweight and there is a high chance that this number will grow each year.

Therefore, one of the treatments for this disease is gastric bypass surgery, but is it possible to get 100% coverage for the expenses involved in this procedure? This plan is specifically designed to answer all your questions about undergoing bariatric surgery, especially through this plan. Check it out here!

What is gastric bypass surgery?

Also known as gastroplasty or bariatric surgery, gastric bypass surgery is a procedure recommended for people with morbid obesity to promote weight loss when other treatments have not yielded positive results.

However, even with surgery, the patient must follow a diet and exercise, as this will help with weight loss, in addition to improving the functioning of the intestines and other organs.

Types of bariatric surgery

Gastric band placement

Using a silicone ring-shaped device around the stomach, this organ is obstructed, resulting in reduced solid food intake. This results in slower, smaller-volume eating, and faster satiety.

This is the least invasive option among bariatric surgeries, causing fewer health impacts. After weight loss, the ring can be removed. However, the patient must have undergone a nutritional reeducation process to avoid regaining weight.

Sleeve gastrectomy

Widely popular, sleeve gastrectomy is much more invasive and one of the procedures that poses the greatest risks to the patient, as it removes a significant portion of the stomach. This reduces its size, as does its capacity to receive food.

However, the patient continues to absorb nutrients, as long as they are ingested in the appropriate quantity, and weight loss and maintenance are more efficient.

Gastroplasty

Gastroplasty is similar to the previous procedure, but the difference is that a gastrectomy cuts the stomach, while in a gastroplasty, the organ is stitched together. This reduces the capacity even further, from 2 L to about 15 to 30 mL.

After weight loss, the stitches can be removed, and the stomach returns to its original capacity. Therefore, it's important for the patient to re-educate their diet to avoid regaining weight.

Gastric bypass

A gastric bypass is when the stomach is cut into two parts, one larger and one smaller. This allows part of the intestine, which is also cut, to be connected to the stomach, forming a direct tubular passage.

Does health insurance cover bariatric surgery?

Finally, since bariatric surgery is listed as a mandatory procedure by the ANS (National Health Insurance Agency), health insurance plans, regardless of the provider, are required to cover it. However, there are certain conditions that the patient must meet to undergo the surgery, bearing in mind that the objective of the surgery cannot be aesthetic.

Types of bariatric surgeries covered by the health plan

The surgeries covered are:

• Restrictive;
• Banded vertical gastroplasty;
• Vertical gastroplasty without bypass;
• Vertical band gastroplasty;
• Mason's surgery.

In addition, the plan must also cover the removal of excess skin (abdominoplasty), but it is necessary:

• Having an “apron abdomen” after undergoing bariatric surgery or clinical treatment and losing a lot of weight;
• Complications such as bacterial infections due to friction, recurrent candidiasis, hernias, or unpleasant odors.

What are the criteria for undergoing bariatric surgery?

To be covered by the health plan, the beneficiary must meet all of the following requirements:

• Be between 18 and 65 years old;
• Clinical treatment carried out for at least 2 years without satisfactory results;
• Presenting morbid obesity for more than 5 years.

Additionally, it must meet one of these criteria:

• BMI between 35kg/m² and 39.9kg/m² with or without comorbidities, i.e. other diseases such as diabetes, hypertension, coronary heart disease, etc.;
• BMI between 40kg/m² and 50kg/m² with or without comorbidities.

However, if the patient presents one of the characteristics below, the plan will not cover the surgery:

• BMI above 50kg/m²;
• Psychiatric problems, psychotic and dementia conditions considered severe or moderate;
• Have used alcohol or illicit drugs in the last 5 years;
• Eating too many sweets.

What is the waiting period for bariatric surgery under the plan?

It turns out that if you purchase a plan already with morbid obesity, you usually have to wait 2 years to make the surgery.

However, if you develop obesity after purchasing the plan, the waiting period will only be 180 days.

In any case, you must meet the required criteria and have a medical report justifying the need for surgery.

How to have bariatric surgery through health insurance?

To request bariatric surgery through the plan, you must schedule an evaluation with a bariatric surgeon, who will analyze your situation and decide whether the procedure is truly recommended and which method is best.

If the professional approves, a series of tests will be carried out, in addition to consultations with other specialists, such as a nutritionist, psychologist, endocrinologist, and cardiologist.