While the second wave of Covid-19 has hit India hard, hospitals across the country are flooded with patients. During these testing times, health insurance is something many families look forward to, as timely financial support can help them sail through these uncertain times. But many of us have doubts about the coverage under health insurance policies. Whether it covers Covid-19 treatment? How to file a claim? In an interview with Money9, Girish Rao, chairman and MD of Vidal Health, talks in detail about coronavirus coverage under a health insurance policy.
Is Covid treatment covered under all types of mediclaim policies?
Girish Rao: There are guidelines from the regulator, and almost all insurance companies are following that the coronavirus hospitalisations must be covered. I think the challenges are largely to do with the sum insured in terms of the coverage and in some cases, maybe the sub-limits in terms of the type of hospitals. But in principle, all policies do cover coronavirus now.
What is the procedure for filing a claim for coronavirus?
Rao: The first preference in my mind should be to pursue a cashless transaction. If the patient has chosen to go outside the network of hospitals, ideally he should submit the claims as soon as he’s discharged from the hospital and send them scanned copies. Now, the regulator has approved and instructed all the insurance companies and TPAs to accept claims through electronic medium. So you could just take on your phone and a lot of insurance administrators have the mobile app. So you can attach your photographs and scanned copies to the app and then send it to the administrator who will process the claims. Typically, these claims are processed within five to seven days.
The finance minister recently asked IRDAI to direct insurers that they should authorise cashless treatment, as many hospitals were not accepting it. Why is there so much pain process around cashless treatment?
Rao: We are at this moment in unprecedented times in terms of the crisis and hence the sensitivity around the whole process is required. I think, by and large, all the hospitals to be fair are accepting patients and making sure that wherever patients are insured they are sending the cashless requests to insurance companies. I think a few outliers are there. Unfortunately, few hospitals are there who have sort of taken the shortcut to this process where they don’t want to answer the insurance companies on why a certain treatment is done.
There is a complexity of how you approach a covid patient and how you treat what kind of protocols you’re following. I would say they are outliers. They are not the core, the mainstream hospitals are providing cashless. Exceptions are there and those get highlighted, unfortunately.
What one can do if a cashless treatment gets denied?
Rao: The good idea would be that whenever a covid patient is being taken to a hospital if a caregiver could call the call centre of the TPA and give the prior intimation that he’s going to a particular hospital. The TPA could also take pro-active action and reach out to the hospital making sure that the necessary documentation needed for the Covid approval is done and provided for. I think in most cases if they reach out very quickly on the way when they’re going to the hospital, I know there is a time constraint, there is anxiety among caregivers about other things in terms of getting the hospital bed and the fear of the whole covid issue. But if they can keep their head cool and reach out to the administrator or the insurance company, I’m sure we could minimise the cases where cashless access is denied.
Is the cost of teleconsultation and make-shift hospitals covered under health insurance policies?
Rao: In many cases, the insurance companies have stepped up and are permitting, the cases. But again, these are purely based on clinical protocols and where is the level of COVID infection. Clearly, in some policies, home care is not permitted. But given the scenario, a lot of insurers are now, especially the public sector companies, are waiving some of these things and approving the home care, too. The cost of medicines even when the patient is sitting at home is significant. So it’s not as simple as the hospitalisation case but surely there is merit in applying for reimbursement. And in some cases, especially where the patient is admitted in a non-hospital environment, those cases are surely being considered.
Are co-morbidities covered along with covid treatment?
Rao: Again, an exception has been made. I think the public sector companies have sort of taken a very positive view of this. As far as Corona is concerned there is a significant view that we must approve every pre-authorization and every claim that is there. In fact over the last six, eight months, the only cases that I have seen that I got rejected are very few.
