I met the other day with a young woman, 38, who weighed roughly 400 pounds. She said she had tried all sorts of diets, medications, “fat farms”, and nothing seemed to have worked. Newly arrived in Israel, frustrated with her lack of weight loss, and what she described as a “culture of fit, anti-fat people”, she wanted to know what her rights were. Is bariatric surgery covered under kupat cholim?
To answer that question, we first need to understand what bariatric surgery is. There are many types of physical interventions to reduce obesity, some covered, some partially covered, and others not at all. I do not profess to be an expert in this field nor is this a medical review to help you select if and which surgery, but rather to understand the system a bit better, as it relates to this issue.
There are three types of physical interventions:
- Operations that restrict amount of food consumed and limits food quantities to the small intestine [ring, gastroplasty, sleeve]
- Procedures to prevent food absorption[(Scopinaro (or) BPD (Bilio Pancreatic Diversion]
- Surgery that combines 1 and 2 [Roux-en-Y Gastric Bypass]
Regular health insurance (meaning that is in the sal habriut) will cover option 1 under the following circumstances:
- The patient has a BMI* over 40 and has attempted weight loss repeatedly and unsuccessfully.
- The patient has a BMI over 35 with a chronic disease associated with obesity (diabetes, etc..).
[*BMI stands for Body Mass Index and it is a general yet relatively effective and well-used formula to determine if an individual is overweight or obese. BMI is your weight (in kilograms) over your height squared (in centimeters).]
If you have supplemental kupat cholim insurance, Maccabi Sheli, Meuhedet “C”, this operation will also be partially covered.
Surgery for excess skin removal after drastic weight loss is not covered in the sal. However, Maccabi will offer that surgery subsidized, if the patient meets the criteria of their committee.
BMI Chart created by Vertex42.com. Used with permission.