Insurance for the mind? Most medical insurance companies disagree

Despite the Mental Health Care Act, 2017, a majority of medical insurance companies are denying insurance coverage for people diagnosed with mental health issues
(Representational Image)
(Representational Image)

KOCHI:  Varun (name changed), a young manager from Kochi, was diagnosed with bipolar disorder and had been undergoing treatment at a private hospital here. When he tried to purchase a medical insurance policy, his eligibility itself was under question. Though they accepted the fee initially, in a few days, he was informed that he could not be issued the policy.

“We regret to inform you that we are unable to provide you with the insurance cover applied in view of the bipolar disorder. The decision is purely on the basis of an underwriting risk assessment done by the company and is not a recommendation on your health status. The amount collected from you shall be credited to the account from which payment was received within seven working days,” stated an email from the insurance company.

In distress, Varun has approached the grievances section of the company, and if a positive reply is not received, he is planning to approach the Insurance Ombudsman and the higher courts. “There still exists a taboo on mental health in the society. However, a health insurance company, that too, in my case, a US-based company, rejecting medical insurance on the basis of my illness is a blatant violation of the law,” said Varun.

Varun’s case is not a rare one. Recently, another man from Ernakulam, who had taken medication for mental health disorders and stopped medicines after getting cured, was denied reimbursement for his medical bills when he was admitted for Covid, said leading psychiatrist Dr C J John, who treated him.

“My patient, who was admitted at the hospital for Covid, had stopped medication for mental health issues long back. Out of honesty, he revealed in the medical history that he had taken psychiatric medicines. The insurance company declined to reimburse his bills that went up to Rs 1.5 lakh. People are forced to hide the details of their illness fearing this situation. Hiding the illness to claim insurance is also spreading stigma on the disease,” said Dr John.

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

Two insurance companies said they were not covering mental health issues. However, they were tight-lipped about why the companies are denying insurance cover for treatment of other illnesses. Dr John said the insurance companies are not even aware that there is an Act prevailing that clearly states that there should not be any discrimination against mental illnesses.

“There are so many such incidents coming to light. Earlier, insurance companies used to reject claims stating that suicide, alcohol and substance use, psychosomatic disorders, etc were excepted. However, the new Mental Health Care Act clearly stipulates that there should not be such distinction. The insurance companies are yet to follow this citing that mental illnesses cannot be assessed using an external factor, like a laboratory cross-checking. In effect, it is very difficult for the insurance company to reject the claim, though it is a loss, according to them, for the company,” says Dr Arun B Nair, psychiatrist from Thiruvananthapuram.

He added that there are two types of classifications to diagnose mental illness -- International Classification of Diseases of WHO and American Psychiatric Associations’ Diagnostic and Statistical Manual. The psychiatrists diagnose the illness on the basis of these two classifications. So, the insurance agencies will have to hire an expert psychiatrist to determine the mental health issues unlike in the cases of other illnesses, where a junior doctor can determine the type of illness. The cost in hiring an expert and the least chances of denying the claims might be discouraging the agencies to give reimbursement in the cases of patients with mental health issues, Dr Arun said. 

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

Related Stories

No stories found.
The New Indian Express
www.newindianexpress.com