Insurers Cannot Reject Cocktail COVID Therapy Claims

The IRDAI (Insurance Regulatory and Development Authority of India) issued a circular asking the insurers to accept the claims towards antibody cocktail therapy used in the treatment of COVID-19. 

The IRDAI has come across many instances where the insurance companies have denied claims or deduction of expenses incurred towards antibody cocktail therapy for the treatment of COVID-19. The insurance companies denied claims for antibody cocktail therapy under the pretext that it is an experimental treatment.

After trying various antibiotics, the doctors started administering antibody cocktail therapy to treat COVID-19 patients as no specific medicine was available to treat COVID-19. Many health insurance companies either denied the claims or denied deducting the cost of the antibody cocktail therapy (containing Imdevimab and Casirivimab) as the doctors started this therapy on an experimental basis.

The Central Drugs Standard Control Organisation (CDSCO) provided Emergency Use Authorisation (EUA) for using antibody cocktail therapy (Imdevimab and Casirivimab) in May 2021 in India. Thus, the IRDAI, in its circular, advised the insurers to review the denied antibody cocktail therapy claims or deductions and take the requisite action for settling such claims according to the terms and conditions of the policy. 

The IRDAI also requested the health insurance companies to implement effective claim settlement procedures to update the approvals or developments given by relevant authorities to settle all antibody cocktail therapy claims. 

The IRDAI also came down heavily on health insurance companies during the onset of the COVID-19 pandemic after they started denying COVID-19 related claims. The IRDAI asked the health insurers to settle COVID-19 claims and issue two COVID-specific insurance products with standard features.

Accordingly, the health insurance companies launched the ‘Corona Rakshak’ and ‘Corona Kavach’ policies to give widespread insurance cover against COVID-19 at a cheaper rate than a full-fledged health insurance policy. 

The COVID-19 cases are increasing daily, and the doctors treat many patients through antibody cocktail therapy. As per the IRDAI circular, the health insurance companies can no longer deny claims or deduct charges for the antibody cocktail therapy used to treat COVID-19 patients, thereby helping people in these difficult times.

For any clarifications/feedback on the topic, don’t hesitate to get in touch with the writer at mayashree.acharya@cleartax.in