Relaxing alternative therapy, but painful insurance claim

Written by Jayati Ghose | Aparna Iyer | Sarita Varma | New Delhi/Mumbai/Thiruvananthapuram | Updated: May 19 2013, 06:23am hrs
Med
Insurers start offering coverage for traditional Indian medicine, but with a catch, due to lack of clarity on issues like pricing & certification

Going for an acupressure session or taking a homeopathy course for that nagging pain in the neck Now you can get your insurer to foot the bill, but dont expect the process to be easy.

Following regulator Irdas notification to insurers to cover alternative therapies like ayurveda, yoga, unani, siddha and homeopathy (Ayush), several insurance companies have started giving expense cover for non-allopathic treatments. The change came into force on February 18 this year. Insurance majors, including Apollo Munich, Reliance General Insurance, SBI General Insurance and Bajaj Allianz, are already providing cover for alternate treatment and others are expected to follow suit.

But insurance companies are still not completely open to the idea. First, not all insurers are ready to offer cover for alternative therapies. Second, several issues like certified hospitals, the fine line between therapy and rejuvenation and standardisation in pricing make the process open to ambiguity.

As SBI General Insurance MD & CEO Bhaskar Sarma says, they dont charge any separate premium for alternative treatments, but offer only a limited percentage of the total cover to them. Within the same premium, the insured is covered up to certain limits. In our case, for ayurveda, 15% of the sum insured and maximum of R20,000 in a policy period is allowed, whereas for homeopathy and unani, 10% of the sum insured, up to a maximum of R15,000, can be availed as reimbursement, he says.

Under Apollo Munichs Insure Health policy, the insured can avail medical expenses for in-patient ayurveda, unani, sidha and homeopathy treatment up to 10% of the sum insured.

However, the bigger catch is that insurance companies insist the treatment should be availed from a certified practitioner and hospitals that are government-owned or institutes that have been accredited by the National Accreditation Board for Hospitals (NABH).

We appreciate the NABH benchmark, but making it the yardstick for insurance coverage is harsh on the thousands of ayurveda doctors who have been validated by the efficacy of their treatment, feels Dr Baby Krishna, secretary, AHMA (Ayurveda Hospital Managements Association). Take the case of Kerala, where only two out of the 25-odd superspecialty ayurveda hospitals are under the NABH fold. A senior manager in one of these superspecialities says they had to undertake a tedious qualification project, coughing up over R10 lakh for the process.

Suresh Sugathan of Bajaj Allianz General Insurance says alternative treatments are covered under the group health insurance scheme only. This is provided on a case-to-case basis looking at the group demographic profile and the premium also depends on the same factors.

Sarma adds that most insurers are selective in coverage, excluding many types of alternative medicine like acupuncture, tai-chi and accept only a few like homeopathy, ayurvedic and unani.

Other challenges also abound. Insurers say standardised pricing for treatments and certification by recognised medical practitioners need to be addressed before coverage can become commonplace for all traditional Indian medicine systems.

There are no authentic studies or database on such traditional treatments to enable us to understand the effectiveness on curing illnesses. If there are some past experiences, they will enable insurers to arrive at a pricing for such treatments. For allopathic treatments there is enough data and records available that can be procured worldwide to arrive at a pricing, adds Sugathan.

Another issue is how to distinguish between treatment and rejuvenation process. Some insurers have now started underlining select procedures under ayurveda or naturopathy to ensure people do not misuse a policy for a basic rejuvenation procedure.

Frankly, the resort concept and rejuvenation marketing have somewhat spoiled the credibility of purists among ayurveda practitioners, says Dr Madhavan Kutty Varier, chief physician at Arya Vaidya Sala, Kottakkal, a healthcare centre specialising in ayurveda.

For an insurance buyer, no standalone cover is yet available for covering alternative treatments. One has to buy a standard health insurance cover from select insurers and others who are offering non-allopathic coverage.

In Kerala, where ayurveda is very popular, the government has been trying to bring in its own style of quality churn to help firms to measure up to the medical insurance bar. It has been toying with a Kerala Accreditation Standards for Hospitals plan for a while. This is yet to come into effect, though technocrat Sam Pitroda, who is on Keralas planning advisory panel, has been hastening insurance cover for Kerala ayurveda therapy.

The Union ministry of health and family welfare has also been expanding alternative medicine under the Ayush programme. As per industry estimates, the market for Ayush, which stood at $1,792 million in 2009, is expected to double to $3,640 million in 2014.

Indias registered homeopathic practitioners alone have more than doubled in two decades from 1.05 lakh in 1980 to 2.46 lakh in 2010. Moreover, the number of homeopathic hospitals/dispensaries has also increased four-fold from 1,686 in 1980 to about 7,000 in 2010.