Data from the General Insurance Council till December 5 shows that 11,229 medical insurance claims worth Rs 106 cr were reported from Kerala. Of these, 8,199 claims worth Rs 45 cr have been settled.
The average claim amount for Covid treatment per patient is about Rs 94,019, of which only Rs 54,372 is settled. The national average is Rs 1.49 lakh, of which on average 62% of the amount is settled. Of the 11,229 persons who had raised insurance claims, 55 died. Till December 5, around 6.31 lakh persons were tested positive for Covid with an average of 1,000 hospitalized in the state. “The insurance company operates in a structured and uniform pricing model whereas private hospitals are uncomfortable accepting the standard rates,” said Mysore Sanjeev, convenor, Project Jeevan Raksha that studies Covid trends in the country. “The matter is now in the Supreme court.”
Hussain Koya Thangal, president of Kerala Private Hospital Association says the insurance reimbursements depend on the type of the policies taken. “Many are not aware of this and end up paying the difference from their pocket.” Private hospital managements, where 51% of the population prefer to be treated, said that only about 20% of Covid patients had medical insurance. Many of them had insurance for treatment of Covid alone. Another 20% in empanelled hospitals were covered under government insurance– either Karunya Arogya Suraksha Paddhati (KASP) or CGHS or any other insurance scheme for government employees or PSUs.
Sources from medical insurance companies said that on average they have 1,000 new claims a week from the state. “Medical insurance companies have been reluctant to cover Covid treatment. They have tried to restrict the claim amount and also insurance cover for the majority of people is less than Rs 3 lakh, which is not enough if a patient develops Covid complications,” said Dr Jayakrishnan A V, chairman of Indian Medical Association’s Hospital Board of India.