Covid-19: Insurers rejecting claims under home treatment adds to woes of citizens

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Insurance Regulatory and Development Authority of India (IRDAI) had last year directed all insurance companies to cover Covid-19 treatment at home under their health policies.

The companies were advised to offer a specialised ‘Corona Kavach’ policy to reimburse Covid treatment costs, including for home treatment.

According to a report in The Times of India, Alpa and Chetan Mehra, siblings based in New Delhi, had claimed insurance under domiciliary treatment for bills of Rs 65,000 due to Covid-19 treatment at home.

Standard line of treatment

But their claim was rejected by their insurer as the ‘standard line of treatment was not followed’. The siblings have reached out to the insurance ombudsman to address their grievances.

Since most patients have mild symptoms, a majority opt for home treatment. They are now finding their claims rejected or settled for a lesser amount.

Companies have capped insurance limits from Rs 15,000 to Rs 20,000 for home care. But this range is very less for those who are undergoing home treatment because of a shortage of hospital beds.

Expert views

“Many claims under the Corona Kavach get rejected because people would have gone for the Rapid Antigen Test instead of RT-PCR test. Besides, the home treatment has to be prescribed by a medical practitioner working in a hospital, many people miss out on these details. And their claims get rejected,” said Shailesh Kumar co-founder of Delhi-based insure-tech startup Insurance Samadhan.

General Insurance Council (GI Council), an association of general insurers, said that home care claims must be reasonable.

“You can’t have exorbitant bills under home care. Our estimates show that it can at best be 20% of what a hospital bill for a case without comorbidities would be,” an official at the Council told the paper.