Do not to deny claims for antibody cocktail therapy to COVID patients, Irdai directs insurers - full report

Insurance regulator Insurance Regulatory and Development Authority of India (Irdai) has asked the general and health insurance providers not to deny claims against 'antibody cocktail therapy' to COVID patients and devise a mechanism to clear such dues as per the norms.

The insurers are denying such claims on the pretext that these are experimental treatments.

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"Authority has come across instances of denial of claims and/or deduction of expenses incurred towards 'Antibody Cocktail therapy' treatment for Covid-19, under the pretext that the said therapy is an experimental treatment," the Insurance Regulatory and Development Authority of India (Irdai) said in a circular issued to the CMD/CEOs of general and health insurers.

Irdai said the antibody Cocktail (Casirivimab and Imdevimab) has been given emergency use authorisation (EUA) in May 2021 by the Central Drugs Standard Control Organisation in the country.
"In light of the above, insurers are advised to review the claims denied/deductions made in such claims and take appropriate action for ensuring that the claims are settled as per terms and conditions of the policy," according to the Irdai circular dated January 7, 2022.

The regulator has also asked the insurers to put in place effective claim settlement procedures to update the developments/approvals given by relevant authorities so that all claims are settled as per the terms and conditions.

Insurance broking firm SecureNow said the circular assumes significance as many of such treatments were legitimate treatments and rejection of claims is a big issue.

There is considerable uncertainty on treatment protocols in the third wave, Kapil Mehta, co-founder, SecureNow, said.

On being asked about the financial bearing on the insurers of this directive from Irdai, he said: "I don't think the cost impact is likely to be large because the use of these cocktail drugs was not extensive".

However, if the claimants go back to the insurers in cases where these costs were declined, then the insurer will have to pay for these on a retroactive basis.

India's active COVID-19 cases have reached 8,21,446 as of January 11, 2022. On Tuesday, a massive number of 1,68,063 fresh COVID -19 infections were reported. The number of active cases is the highest in around 208 days, according to data from the Health Ministry.

As per studies, the 'Antibody Cocktail Therapy' for COVID-19 can prevent escalation of mild and moderate illness to severe, which then requires hospitalisation in 70 per cent of the cases, Dr Sandeep Nayar,

Senior Director, BLK-Max Centre for Chest and Respiratory Diseases, had said in June last year when the hospital had administered this therapy to two COVID-19 patients.

The cocktail contains 1,332 mg each of Casirivimab and Imdevimab. A pack contains two vials, so two patients can be treated. Each vial for a person costs about Rs 59,750.