Simply put: AYUSH covers

Two friends discuss alternative treatments in medicine and the scope of insurance coverage comes into focus.

Siddha: Even though allopathic or western medicine has made great strides; I find that the traditional medicine appeals to some patients, or therapies.

Younis: True. My grandfather tried several treatments before finding relief in Ayurvedic medicine for his constant gastric troubles.

Siddha: Yes, government initiative through Ministry of AYUSH covers Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy comprehensively. One can only hope that insurance, pharmacy, and other support services around AYUSH also catch up with the initiative.

Younis: I gather that you are not aware. AYUSH treatments are covered by health insurance companies. Just as one would claim insurance for treatments, AYUSH treatments are covered by health insurance.

Siddha: Oh my! I did not know that. Is there any difference?

Younis: Just as inpatient hospitalisation is a prerequisite for health covers to kick in, AYUSH treatment would also need admission to the facility to start coverage. If the AYUSH facility is Centre or State-managed, then insurance claims will be admitted. But in other cases, each insurer will have specific conditions to be met to qualify for coverage.

Siddha: What might those conditions be? I feel it is better to check with the facility before admission if insurers have empanelled that facility.

Younis: Insurers will specify the number of in-patient beds, administration capabilities, qualified practitioners in the system with round-the-clock attendance, daily record maintenance and others. But yes, check with the front desk before admission if the facility is empanelled.

Siddha: But what about consultations?

Younis: Well, this is where insurance covers might get tricky. Most of the treatments in these specialities might not require hospitalisation and rather work with outpatient consultations or what is known as OPD treatment. In the rare case that OPD expenses specific to AYUSH are covered by health insurers, the sub-limit might not be sufficient for the treatment course. This sub-limit for OPD treatment is applicable for any treatment, allopathic or AYUSH.

Siddha: Yes, consultations are crucial, and it is a pity that this option is not well covered, AYUSH or otherwise. But I hope the cashless facility is right up there even for AYUSH.

Younis: No difference there. If the facility accepts insurance, you can avail cashless facility or you can claim reimbursement just as with allopathic treatment from hospitals.

Siddha: Thanks Younis. I am glad that AYUSH is well covered in health insurance.

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