Health insurance claims: Health insurers cannot reject Covid claims for antibody cocktail therapy: Irdai

With cases of the Omicron variant of the coronavirus rising sharply in India and specific drugs still not available to fight the virus, many people are turning to antibody cocktail therapy. The cost of antibody cocktail therapy can be quite high. Keep this in mind, the Indian Insurance Regulatory and Development Authority (Irdai) has asked health insurance companies not to dismiss Covid’s claims for antibody cocktail therapy as “experimental.”

According to a Times of India report, the regulator ordered insurers to assess denied claims or deductions made in all of these cases and take appropriate action to pay them in accordance with the terms of the policy.

According to the ToI report, the circular to the heads of all non-life and health insurance companies came following complaints that many insurers are rejecting treatment requests for the third wave where hospitals have used new drugs. expensive antivirals. “The authority has encountered cases of denial of claims and / or deduction of expenses incurred for the treatment of ‘antibody cocktail therapy’ for Covid, on the pretext that said therapy is an experimental treatment,” said the ToI citing the Irdai circular.

According to the ToI report, the regulator pointed out that the antibody cocktail (Casirivimab and Imdevimab) received emergency use authorization in May 2021 from the Central Drugs Standard Control Organization in India. All health insurance policies have a clause that excludes experimental treatments. The goal is to ensure that the 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 cells. Drugmakers in India had launched the antibody cocktail in May 2021 at Rs 59,750 for each patient dose of 1,200 mg (600 mg Casirivimab and 600 mg Imdevimab).

Mumbai City Commissioner Iqbal Singh Chahal told The Economic Times last week that most patients referred to private hospitals have minor symptoms of Covid and are being treated with Molnupiravir. “They are only admitted for a day or two and then released.” “Health insurance companies have told us that only patients admitted for at least one day can be considered for release of insurance payments,” said Chahal.

He went on to say that BMC would pursue this with the insurance companies.