Insurance policy will not cover all kinds of in-home treatment

Only if it is recommended by the doctor or if it is post-surgery treatment.

You have been advised physiotherapy for your chronic back ache and you opt for treatment at home. Chances are that your health insurance policy will not cover it. But if you had been advised  physiotherapy after a surgery, then the same policy would have covered it, as it will fall under the domiciliary or post-hospitalisation treatment. 

But if your health insurance policy offers cover for Out Patient Department (OPD) or day care procedures, then physiotherapy would be covered, even if it is not linked to a surgery. However, premiums for such covers are almost three times that of a regular health insurance cover.

According to Vivek Desai, managing director of Hosmac (a healthcare consulting firm) and a practising doctor, in-home treatment largely comprises three segments. One is geriatric care, which is treatment for senior citizens who find it difficult to go to hospitals. Service providers like Portea offer in-home medical services catering to this segment. Second is treatment for chronic ailments, which requires continuous monitoring, such as physiotherapy or diabetes. Firms like Nightingale, based out of Bangalore operate in this segment. The third is post-discharge treatment, such as dressing of wounds, etc, which is often provided by hospitals themselves. 

"In-home treatment is a growing healthcare segment. Currently, only post-discharge treatment is covered under health insurance. In-home treatment for geriatric and chronic ailment is not covered by insurance,'' Desai says.

Any kind of domiciliary treatment will be covered provided the doctor recommends it, says Deepak Yohanan, CEO, MyInsuranceClub.com. This will be based on the doctor's certification. But it is better to inform your insurer in advance and take prior approval because it may vary from case-to-case. If it is a genuine case, then the company may allow the claim. 

"Thanks to medical advancement certain procedures today do not require hospitalisation. So, many of these are covered by health insurance today. But for other treatments the policy must offer OPD cover, in which case premiums are higher,'' he says. 

Not too many companies offer OPD covers. And given that premiums are almost three times higher than a regular health policy, it may not be very beneficial for everyone.

"Most people do not utilise OPD benefits. While senior citizens may utilise OPD benefits, premiums in their case can be very steep,'' Yohanan says. 

Demand for in-home medical treatment is on the rise, because patients are more comfortable at home, especially if recurrent treatment is required. But costs must be reasonable, says Renuka Kanvinde, Associate vice-president, Health Insurance, Bajaj Allianz General Insurance. Other than cost, insurance companies will also check quality of service, which too is tougher to monitor in case of in-home treatment, as against hospitalisation. 

Max Bupa Health Insurance covers home care services for the elderly if prescribed by the treating doctor, says Somesh Chandra, Chief Operations Officer and Chief Quality Officer."While home care can be instrumental in reducing healthcare costs, standardisation with some basic protocols including empanelment of doctors is a key requirement. Standardisation protocols would enable such services to become more streamlined and easier to administer,” he says.

Some insurers offer tie-ups with healthcare companies that provide in-home services. If that is so, the claim may get paid only if you avail the service from those particular service providers. But remember that such value-added services will push up your overall premium. 

Besides, coverage for in-house treatment, often, will not include alternate medicines like Ayurveda, because it is difficult to clinically evaluate the requirement for the particular treatment. "In case of Ayurvedic treatment, only hospitalisation at a government recognised hospital is covered. For instance, if it is a massage taken at home, it will not be covered. But if the massage is taken in a hospital, then there is a diagnosis and doctor's advice,'' she says. Bajaj Allianz is one of the insurance companies that offer coverage for Ayurvedic treatment.