The circular to the chiefs of all non-life and health insurance companies has come following complaints that many insurers are rejecting claims for treatment in the third wave where the hospitals have used expensive new antiviral drugs. “Authority has come across instances of denial of claims and/or deduction of expenses incurred towards ‘antibody cocktail therapy’ treatment for Covid, under the pretext that the said therapy is an experimental treatment,” the Irdai said in its communication.
The regulator pointed out that the antibody cocktail (Casirivimab and Imdevimab) has been given emergency use authorisation in May 2021 by the Central Drugs Standard Control Organisation in India. All health insurance policies have a clause that excludes experimental treatments. The objective is to ensure that money is spent on proven or established techniques. This clause has been used by insurers in the past to exclude robotic surgeries and new treatments like stem cell.
Drugmakers in India had launched the antibody cocktail in May 2021 at Rs 59,750 for each patient dose of 1,200mg (600mg of Casirivimab and 600mg of Imdevimab).
Last week, Mumbai municipal commissioner Iqbal Singh Chahal had told The Economic Times that most of the patients admitted to private hospitals have mild Covid symptoms and are taking Molnupiravir drug treatments. “They are getting admitted to hospitals for a day or two and getting discharged. We asked hospitals to get these people treated at outpatient departments. The private hospitals have told us that the health insurance companies have a rule that only patients admitted for at least a day can be considered for releasing insurance payments,” Chahal said.
He added that BMC would be taking this up with insurance companies.
Speaking to TOI, an insurance official said that according to their in-house medical team, there has been an abuse of insurance by some healthcare providers who have prescribed the antibody cocktail for non-severe cases. According to them, an increase in the claims’ payout would eventually add to the cost of health insurance.
According to insurers, health insurance policies do not cover domiciliary treatment as they cannot ascertain the actual cost of treatment as pharmacies are liberal in issuing medical bills for general provisions.