September 24, 2019
It may be customary for insurance companies to find reasons for rejecting claims. And a traditional healing system that Ayurveda is, finds that it becomes the easiest target for such rejections, claim physicians and patients.
It was a sordid struggle for Ajay Richura of Coimbatore to get the assured insurance claim for treatment of his wife at an Ayurveda hospital, matching the hardships his wife underwent owing to the illness.
But it is not just Raichura who has had to face sidelining of auyrveda by insurance authorities. It is a tale for many.
In this case, after nearly over a decade of insurance cover by a PSU insurance firm, Ajay switches to a private firm after he is contacted by an agent. The policy was quoted. After around six months, he goes in for a claim for the treatment his wife had to undergo at an Ayurveda hospital in Coimbatore for three weeks. She had been admitted to the government-recognised hospital which has is nationally and internationally acclaimed.
He submitted his claim to the local branch and not very later he was informed that the claim was rejected. He then had to petition the grievance committee which too found some reason or the other to reject it. They even cited an X-ray film taken to be reason for previous illness that was not revealed during taking the policy. This was during the earlier part of this year.
Refusing to be beaten down, he approached the insurance ombudsman and presented his case immediately. The private insurance firm which had already run into trouble failed to present its case properly as all facts were on his side. The ombudsman raised matters which the insurance firm could not convincingly counter. This dragged on for three months and in between, the insurance firm tried to get details of an MRI scan which, he argued, was getting into his privacy. He had, when covered by the PSU insurance firm earlier, got his claims.
To cut a long tale short, Raichura was finally awarded his Rs 1 lakh claim with interest of 9 per cent.
He says that often when a claim is rejected, people give up as going to a consumer court would take years for the matter to get settled. It is ideal for the consumer to approach the insurance ombudsman as a clear result would be got at the earliest.
A private insurance agent, on condition of anonymity, admitted that it is the `policy’ of the insurance firm to try find ways to reject an application for claim. This becomes easier if it is for Ayurveda treatment as often there is a misconception that this has to do with the mushrooming massage centres.
It has to be noted that recently the draft circular of the insurance regulator IRDAI came out with draft norms for standard health insurance products with a basic sum assured of Rs 50,000 to Rs 10 lakh defining the benefit structure for individual insurance buyers. This would cover expenses incurred under Ayurveda, Unani, siddha and homoeopathy systems of medicines.
However, in the wake of private players too entering the insurance market, especially foreign ones, there is the tendency to keep traditions healing systems like Ayurveda out of its ambit.
This needs to be countered since such systems are recognised in the country and have been traditionally been followed over centuries and have proved to be successful.
A practising Ayurveda doctor told The Covai Post that it was a lobby that worked against such traditional systems. He points out that there were a few instances where he had to treat patients who were rejected by allopaths. And when the issue of their claims being rejected on flimsy grounds, some of the patients moved the consumer court. He admits that it took a few years before their matter got settled and in some cases they got the claims settled. However, he said that this concept of going to the insurance ombudsman was something he could advise patients who wanted to make an insurance claim.
Ayurveda physicians generally feel that concerted attempts to keep this system out of insurance cover is part of a `larger conspiracy’ and has to be dealt with strongly.
An Ayurveda post-graduate student specialising in gynaecology says the texts on this subject are aplenty and is dealt with very widely. But given the strong anti-ayurveda lobby it would be a tough task surmounting it to convince people of how effective this system works. Even insurance claims connected with woman-related issues would be countered by companies. There has to be concerted effort in creating awareness and a strategy to get Ayurveda recognised by insurance companies, she adds.