Chennai / Hyderabad: Siblings Alpa and Chetan Mehta have racked up Rs 65,000 bills under Covid-19 treatment at their home in New Delhi. Although they were covered for home treatment, their claim was rejected by their insurer because “the standard line of treatment was not followed”. The Mehtas have contacted the Insurance Ombudsman and are awaiting a response.
In April, 61-year-old T Vijaya from Hyderabad filed a claim for 19,400 rupees for Covid-19 home treatment, but only received 12,000 rupees under his family retirement plan.
Last year, the IRDA ordered all insurers that offer home treatment as part of their health insurance policies to cover Covid-19 home treatment. Companies have also been urged to offer a specialized ‘Corona Kavach’ policy to reimburse Covid treatment costs, including for home treatment. Yet many companies do not cover home treatment for Covid-19.
Since most patients have mild symptoms, the majority opt for home treatment. They now find their claims rejected or paid for a lesser amount. Companies have limits ranging from 15,000 rupees to 20,000 rupees for home care. For those seeking home treatment due to a shortage of oxygen hospital beds, the limits are woefully inadequate. “We need to sit down with our actuaries and see if any requests for higher limits are possible,” said United India Insurance CMD Girish Radhakrishnan, “The demand is coming from our corporate clients.” United India has a limit of Rs 15,000 for home care, while for a selected category of policies there are no such limits.
“Renting oxygen cylinders is enough to erase the limits. In addition, teleconsulting with infectious disease specialists or pulmonologists can cost as much as Rs 1,500 per session, ”said Sanjay Datta, Claims and Underwriting Manager at ICICI Lombard. ICICI Lombard only covers claims for in-home hospital-type treatment and excludes police quarantine costs.
Star Health, which was among the first to introduce plans for the home, offers a kit that includes a pulse oximeter and a thermometer. “We have set a limit of Rs 20,000 which will be sufficient to cover mild infections. If the infection is moderate to severe, the insured will go to the hospital, ”Star Health doctor Dr S Prakash said.
Insurance Samadhan co-founder Shailesh Kumar said: “Many Corona Kavach claims are being rejected because people would have opted for the rapid antigen test instead of the RT-PCR test. In addition, home treatment must be prescribed by a doctor working in a hospital … many people miss these details. And their claims are rejected. ”
General Insurance Council (GI Council), an association of general insurers, said home care claims must be reasonable. “You can’t have sky-high bills for home care. Our estimates show that this may at best be 20% of what a hospital bill would be for a case without co-morbidities, ”a council official told TOI.