Mumbai: India Insurance and Development Arrangement Authority (Irdai) has asked the company not to refuse Covid claims for antibody cocktail therapy by paying attention to ‘experimental’ treatment.
Regulators have also requested insurance companies to review rejected claims or deductions carried out in all such situations and take appropriate actions to settle them in accordance with the provisions of the policy.
Tanction to the head of all non-soul and health insurance companies has followed the complaint that many insurance companies refuse claims for treatment in the third wave where hospitals use expensive new antivirus drugs.
“Authority has found an example of a claim and / or cost reduction that occurs against the treatment of ‘antibody cocktail therapy’ for Covid, with the pretext that the therapy is experimental treatment,” Irdai said in his communication.
The regulator shows that the antibody cocktail (Casarivimab and IMdevimab) has been authorized emergency use in May 2021 by the standard drug standard control organization in India.
All health insurance policies have clauses that exclude experimental care.
The aim is to ensure that money is spent on proven or established techniques.
This clause has been used by insurance companies in the past to exclude robot operations and new care such as stem cells.
Drug makers in India have launched an antibody cocktail in May 2021 at Rs 59,750 for each patient dose of 1,200mg (600mg casingivab and 600mg from IMDEVIMAB).
Last week, Commissioner Mumbai Municipal Iqbal Singh Chahal said that in the economic period that most patients received in private hospitals had symptoms of covid mild and used treatment of molnupiravir medicine.
“They were hospitalized for one or two days and were sent home.
We asked the hospital to get these people being treated in the outpatient department.
Private hospitals have told us that health insurance companies have rules that only patients claim to be at least a day Can be considered to release insurance payments, “Chahal said.
He added that BMC would take this with insurance companies.
Speaking to Toi, an insurance official said that according to their in-house medical team, there had been insurance abuse by several health care providers who had prescribed antibody cocktails for non-severe cases.
According to them, increasing payment of claims will ultimately increase the cost of health insurance.
According to insurance companies, health insurance policies do not include domiciliar treatment because they cannot ascertain the cost of actual treatment because of the liberal pharmacy in issuing medical bills for general provisions.