Insurance for the mind? Most Medical Insurance Companies Disagree – The New Indian Express

Express press service

KOCHI: Varun (name changed), a young manager from Kochi, was diagnosed with bipolar disorder and was undergoing treatment at a private hospital here. When he tried to purchase a medical insurance policy, his eligibility itself was in question. Although they initially agreed to the charges, a few days later he was told he couldn’t get the police.

“We regret to inform you that we are unable to provide you with the requested insurance coverage due to bipolar disorder. The decision is purely based on an underwriting risk assessment performed by the company and is not a recommendation on your medical condition. The amount collected from you will be credited to the account from which payment was received within seven working days,” an email from the insurance company said.

In distress, Varun approached the company’s claims section, and if a positive response is not received, he is considering going to the insurance ombudsman and the higher courts. “There is still a taboo on mental health in society. However, a health insurance company, which also in my case a US-based company, rejecting medical insurance based on my illness is a clear violation of the law,” Varun said.

Varun’s case is not uncommon. Recently, another man from Ernakulam, who had taken medication for mental health conditions and stopped the drugs after being cured, was denied reimbursement for his medical bills when admitted for Covid, said said the chief psychiatrist, Dr CJ John, who treated him.

“My patient, who was admitted to hospital for Covid, had stopped medication for mental health issues a long time ago. Out of honesty, he disclosed in the medical history that he had taken psychiatric medication. The insurance company refused to reimburse her bills which amounted to Rs 1.5 lakh. People are forced to hide the details of their disease for fear of this situation. Hiding the disease to claim insurance also spreads the stigma of the disease,” said Dr John.

According to Section 21(4) of the Mental Health Care Act, all insurers are obliged to provide medical insurance for the treatment of mental illnesses, just like physical illnesses. This provision was included following the ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Article 25 of the UNCRPD deals with health and its subparagraph (e) provides for the prohibition of discrimination in health insurance against persons with disabilities. [4].

Two insurance companies said they did not cover mental health issues. However, they were tight-lipped about why companies deny insurance coverage for treatment of other illnesses. Dr John said insurance companies don’t even know there is a law in place that clearly states there should be no discrimination against mental illness.

“There are so many incidents like this coming to light. Previously, insurance companies rejected claims stating that suicide, alcohol and substance abuse, psychosomatic disorders, etc. were excluded. However, the new Mental Health Care Act clearly states that there should be no such distinction. Insurance companies have yet to follow this up citing that mental illnesses cannot be assessed using an external factor, such as a lab cross-check. Indeed, it is very difficult for the insurance company to reject the claim, even if it is a loss, according to them, for the company,” says Dr. Arun B Nair, a psychiatrist from Thiruvananthapuram.

He added that there are two types of classifications for diagnosing mental illness: the WHO International Classification of Diseases and the American Psychiatric Associations Diagnostic and Statistical Manual. Psychiatrists diagnose the disease based on these two classifications. Thus, insurance agencies will have to hire an expert psychiatrist to determine mental health issues unlike cases of other illnesses, where a junior doctor can determine the type of illness. The cost of hiring an expert and the lower chance of denying claims could discourage agencies from reimbursing cases of patients with mental health issues, Dr Arun said.

Conscious laws
According to Section 21(4) of the Mental Health Care Act, all insurers are obliged to provide medical insurance for the treatment of mental illnesses, just like physical illnesses. This provision was included following the ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Article 25 of the UNCRPD deals with health.

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