Insurers ‘silent’ on ‘no cover’ for new therapies – The Hindu BusinessLine

Clipped from: https://www.thehindubusinessline.com/news/covid19-treatment-health-insurers-wary-of-covering-costs-of-new-therapies/article34852247.ece

Some of the Covid therapies are expensive costing patients anything between ₹60,000 and ₹5 lakh

New therapies for the treatment of Covid-19 may hold out promise, but the problem is they are pricey and not covered by general health and even coronavirus-specific insurance policies.

Several private hospitals are using these new therapies and drugs in view of their ‘efficacy’. However, some of these therapies are expensive — costing patients anything between ₹60,000 and ₹5 lakh, depending on the patient’s level of infection, according to information provided by hospitals.

A senior official of a leading private general insurer told BusinessLine that the monoclonal antibody therapy and cocktail treatments, for instance, are not covered under the health policies. “This is because most of these treatments do not involve hospitalisation and also are not on the list of drugs/treatments advised by the Indian Council of Medical Research,’’ he said.

Monoclonal antibodies

But there is an increasing recourse to new therapies. According to K Subba Reddy, Head of Critical Care, Apollo Hospitals, new therapies include the use of monoclonal antibodies, Tocilizumab, Barcitinib, Tofatanib, Anakinra, stem cell therapy, low-dose radiation, colchicine, cytokine filter, and 2 Deoxy Glucose.

“Out of all these, monoclonal antibodies are most commonly used. Barcitinib is used only in those who go onto a ventilator (20 per cent of patients0, or ECMO patients (5 per cent),’’ Reddy said.

Lack of clarity

There is a lack of clarity on the applicability of insurance cover on many of these therapies which is reflected in the ‘silence’ of general insurers on the issue. Out of five general insurers contacted by BusinessLine, only two shared information, off the record.

“There has been a huge payout of claims on account of Covid cover being offered under specific policies such as Corona Kavach (mandated by the insurance regulator) and general health insurance. There is a need to tread cautiously, and regulatory clarity is needed on the matter for the benefit of all stakeholders,’’ said the chief of underwriting of a private insurer adding that “there are fake certificates and claims, too, in some cases of Covid cover.’’

But patients are at the receiving end as the final settlement in a majority of Covid cases is only in the range of 50-65 per cent of the claim.

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