Insurers can’t reject cocktail Covid therapy

Mumbai: The Insurance Regulatory and Development Authority of India (Irdai) has asked companies not to reject Covid claims for antibody cocktail therapy by terming it as an ‘experimental’ treatment. The regulator has also asked insurers to review claims denied or deductions made in all such situations and take appropriate action to settle them according to the terms of policy.
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 Irdai said.
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).
Last week, Mumbai municipal commissioner Iqbal Singh Chahal had told The Economic Times that most patients admitted to private hospitals have mild Covid symptoms and are taking Molnupiravir treatments. “They are getting admitted for a day or two and getting discharged. The private hospitals have told us that the health insurance companies have a rule that only patients admitted for at least a day can be considered for releasing insurance payments,” Chahal said.
He added that BMC would be taking this up with insurance companies.