health insurance claims: Health insurers can’t reject Covid claims for antibody cocktail therapy: Irdai

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With cases of the Omicron variant of the coronavirus surging in India and specific medication 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 Insurance Regulatory and Development Authority of India (Irdai) has instructed health insurance companies to not reject Covid claims for antibody cocktail therapy as “experimental.”

According to a Times of India news report, insurers have been ordered by the regulator to assess claims denied or deductions made in all such cases and take appropriate action to pay them according to policy conditions.

According to the ToI report, the circular to the chiefs of all non-life and health insurance companies has come following complaints that many insurers are rejecting claims for treatment in the third wave where the hospitals have used expensive new antiviral drugs. “Authority has come across instances of denial of claims and/or deduction of expenses incurred towards ‘antibody cocktail therapy’ treatment for Covid, under the pretext that the said therapy is an experimental treatment,” the ToI quoted the Irdai circular.

According to the ToI news report, the regulator pointed out that the antibody cocktail (Casirivimab and Imdevimab) has been given emergency use authorisation in May 2021 by the Central Drugs Standard Control Organisation in India. All health insurance policies have a clause that excludes experimental treatments. The objective is to ensure that 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 cell. Drugmakers in India had launched the antibody cocktail in May 2021 at Rs 59,750 for each patient dose of 1,200mg (600mg of Casirivimab and 600mg of Imdevimab).

Iqbal Singh Chahal, Mumbai municipal commissioner, told The Economic Times last week that most patients referred to private hospitals have minor Covid symptoms and are being treated with Molnupiravir. “They’re only admitted for a day or two and then released.” “The health insurance companies have instructed us that only patients admitted for at least a day can be considered for releasing insurance payments,” Chahal said.

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

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