The Hindu Business Line : Insurance cos wary of ayurveda treatment claims

Mumbai April 2 Patients going in for Ayurvedic or other alternative treatments may find it more difficult to get health insurance, as insurers have restricted the scope of covers for these methods.

New India Assurance and Oriental Insurance Companies, two leading health insurers in the country have restricted the cover, recognising only claims made from Government hospitals.

Currently, Ayurveda, Homeopathy and Unani are accepted as alternative methods, though Acupuncture and Acupressure are seen as being unproven and experimental.

New India Assurance, which is soon to launch its new health insurance policy, has also imposed a ceiling of 25 per cent on the total amount insured if alternative systems of medicine are used. Most private players do not insure any alternative treatments.

Unorganised sector

"Earlier, a policyholder could claim reimbursement from any hospital - Government or private. But the proliferation of spas in places like Kerala, Goa and Bangalore has resulted in a number of claims being filed even for an oil massage or steam bathing," said the senior official at a public sector non-life insurance company.

It is difficult to get insurance coverage for Ayurvedic treatments because the sector is largely unorganised, said the head of a corporate hospital chain.

Although claims from alternative treatments account for just one per cent of the total, third party administrators (TPA) say that a number of claims are refused because they are ambiguous. The concern in Ayurvedic treatments is that the procedure may not be linked with the disease. It remains unclear whether the treatment is for `illness' or `wellness'.

"An oil massage could help a sportsman run faster, but it may also make a lame man walk," said Mr Praful Bhalerao, CEO, Genins TPA. And these treatments may not always necessitate hospitalisation, where by the dispute occurs, he added.

The Charak Pharma's Chief, Mr Pulin Shroff, observes that insurers leave out Ayurvedic medicines while reimbursing bills.

At least established Ayurvedic treatments in segments such as heart-ailments, arthritis, skin-problems and fertility, can be covered by insurance companies, he said.

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