Case Discussions by SCARF on Mental Health Insurance

MedPiper Technologies and JournoMed covered a panel discussion of Schizophrenia Research Foundation (SCARF) conducted on 28th June, 2022, that addressed topics on Mental Health Insurance and case discussions regarding the same.

Case Scenario 1

Dr Meenakshi, Consultant Ophthalmologist initiated the panel discussion and discussed a case of chronic psychotic illness. The patient approached SCARF for medication and some medical health insurance companies like United Health Insurance regarding coverage for the medical expenses. Almost all the companies denied providing it. Many individuals are not aware of such scenarios unless and until they are hospitalized or have to seek treatment.

Mr Sanjay Pinto, Advocate, Columnist, Author and Former Resident Editor for NDTV 24/7 tried to clarify the above case and stated that insurance companies have violated the Mental Health Care Act (2017). He explained the role of Insurance Regulatory and Development Authority (IRDAI) in enforcing this act. The IRDA had issued a circular to ensure that anyone from any back ground can obtain appropriate and affordable treatment for mental illness.

This organisation supervises the functioning of the insurance companies to ensure that there is no discrimination against those who seek policy coverage especially for mental health illness. As per the constitution, any individual can claim medical aid which is a preliminary right. Most of the hospitals, insurance companies and the citizens are not aware of Mental Health Care Act. Most hospitals deny admitting mentally ill patients as it may relate to safety measurements with regard to other patients.

Case Scenario 2

Ms Narjis Hussain, a freelance writer from New Delhi spoke about the Mental Health Insurance act and case regarding a lady doctor who is suffering from mental illness. The patient approached health insurance companies for policy and then she approached Dr Harish, a renowned psychiatrist. Her case was forwarded to IRDAI. After 4 weeks of waiting, the insurance company denied providing mental health insurance. After Ms Narjis got involved, it was understood that not everyone knows about the Mental Health Care Act. Many companies even tried to misguide the patient. Nearly 50-75 medical insurance applications were rejected because of a tendency to give up and no proper follow-up. Such situations made it very difficult for patients to claim their medical insurance.

Mr T K Muthu said that at the time of getting a health insurance policy, one needs to perform a complete body check-up. Almost all of the insurance companies have tie-ups with hospitals and other private medical agencies which can help aid in obtaining the insurance. Treating mental health illness can be claimed under insurance if it is performed by qualified health care professionals.

What can be done to help bring Mental Health Insurance to the forefront?

Ms Hussain said that awareness must be created to bring in the support of the government executives and the media needs to play an active role in spreading it. It is the prime duty of the media to bring necessary attention to policy issues and mental health-related program issues. Awareness must also be spread among the masses to get rid of social stigma. Everybody must be aware of mental health which is considered a fundamental right. From 2021 April onwards, it is amended that all general insurance policies must cover mental illness.

Mr Sanjay Pinto explained that a strict law must be enforced in order to obtain mental health insurance from the insurance companies. For not getting the insurance, one can sue the company for the violation of the fundamental right. These insurance companies are governed by IRDAI, a statutory body which has rich jurisdiction in the high court.

These policies must be citizen-friendly, patient-friendly and customer-friendly. The scenario of medical insurance and problems in claiming them was clearly seen during the COVID-19 pandemic. Insurance has become a basic necessity these times and comes to rescue during any medical emergency. An insurance policy is recommended during the patient’s entire hospitalization stay.

Conclusion

Today, in a family, nearly 5-10 lakhs were being spent on medical expenses which was clearly observed during the pandemic. Most of the patients suffered in claiming the insurance which drained them morally, emotionally and financially. After observing such scenarios, it is the government’s responsibility to promote public health and action should be taken regarding the proper amendment of the Mental Health Care Act, through which the mentally ill individuals can gain benefits.