In India, insurance companies are increasingly rejecting claims for unrelated medical conditions by using patients’ mental health treatment records, a practice that has sparked widespread opposition. Conditions such as depression or obsessive-compulsive disorder (OCD) are being cited as reasons to deny claims for surgeries like cataract or heart operations. This issue gained significant attention after actor Archana Kavi shared her personal experience of a claim denial, raising awareness about the practice.
Challenges in Insurance Coverage for Mental Health Despite Legal Mandates
Despite the Mental Healthcare Act of 2017 mandating equal treatment for both physical and mental health conditions, hospitals known for their mental health services are facing a rising number of complaints from patients whose insurance claims have been denied. This practice not only worsens the stigma surrounding psychiatric care but also deters people from seeking help or disclosing their mental health struggles, fearing it may impact their insurance coverage.
The Insurance Regulatory and Development Authority of India (IRDAI) mandated in November 2022 that all health insurance policies must cover mental health conditions. However, the implementation of this regulation has been inconsistent, and many patients still encounter challenges in getting claims approved for procedures unrelated to their mental health history.
Insurance Claim Denials Due to Mental Health History: Growing Concerns
Ajinas from Ernakulam expressed his frustration after his mother’s cataract surgery claim was rejected because of her depression history. Despite the surgery being performed at a reputable hospital, the insurance company denied the claim after questioning her mental health treatment history. Similarly, Vivek Raj from Alappuzha had his treatment claim denied due to his history of bipolar disorder.
Some insurance policies are becoming more restrictive by requiring patients to prove at least a 40% disability to qualify for coverage of mental health conditions. This clause has faced strong criticism from health professionals, as it is challenging for many mental health patients, including those with depression or OCD, to meet this requirement. Critics argue that such policies contradict the intent of the Mental Healthcare Act, making it more difficult for individuals with mental health histories to obtain insurance coverage.
