Rejection of insurance claims for rising antibody cocktail

Even though the number of Covid-19 cases is seeing a sharp increase as a result of the new Omicron variant, there has been a steady increase in demand for monoclonal antibody cocktail therapy. While insurance companies say they have honored claims arising from this line of treatment, hospitals say there has been an increase in rejections as insurers say it is an experimental drug treatment.

Antibody cocktail therapy (Casirivimab and Imdevimab) is given together as soon as possible after a positive test for Covid and within 10 days of onset of symptoms. It is generally administered to elderly Covid patients who are prone to multiple co-morbidities such as diabetes, hypertension, diseases related to the heart, liver, kidneys; post-transplant patients; as well as those undergoing chemotherapy. The drugs usually come in two doses, each costing between 56,000 and 60,000.

According to Dr. S Prakash, CEO of Star Health and Allied Insurance, cocktail antibody therapy has been found to be effective against the Delta variant. However, experts have expressed concerns about the effectiveness of the treatment of the Omicron variant.

“We have to be very careful and any abuse of such a cocktail antibody should be avoided,” Prakash said. Activity area.

Rising demand

Hospitals in Calcutta confirm that with the increase in the number of cases, there has been an increase in demand for antibody cocktail therapy compared to the second wave caused by the Delta variant.

“Typically 10% of the total number of patients admitted for Covid receive this therapy at the early stage of symptom onset before they begin to witness a drop in oxygen saturation levels,” said Dr Aviral Roy, consultant – Intensive care, Medica Superspecialty Hôpital.

Fewer hospitalizations

However, with the Omicron variant, it might not be as effective, Roy said, adding that there had been an increase in releases based on experimental drug therapy.

Since Omicron is still considered milder and is not as virulent as the Delta variant, there may be less need for hospitalization. If there is no hospitalization, insurance companies may not want to honor the claims, said P Nandgopal, founder and CEO of Insurance Inbox.

“IRDAI guidelines have been followed”

“In accordance with the IRDAI directive, all approved Covid treatments are covered by insurance and we pay the claims. However, hospitals should not force therapy on people who may not need it, ”said Sanjay Datta, chief underwriting, claims and reinsurance, ICICI Lombard General Insurance.