‘Middle class struggles to claim mental health insurance’

New Delhi: ‘During the pandemic, the importance of mental health has increased as the negative impact of economic recession and the rise of substance use disorders has grown. According to several reports, roughly 10.6% of adults in India experienced some form of mental illness in 2021. However, mental health issues are not new; the Mental Healthcare Act of 2017 went into effect in 2018, with the amendment of decriminalising attempted suicide, which was formerly penalised under Section 309 of the Indian Penal Code. However, brokers dealing with various insurance firms in India continue to violate the rules by using a variety of reasons to deny policyholders’ claims. On the other hand, the majority of insurers are uninformed of the act’s provisions and their rights.
Interestingly, several public insurance firms, such as National Insurance Company Limited and Oriental Insurance Company Limited, started including mental illness in their policies during the pandemic, and only compensated the hospital or the insurer if the patient was hospitalized. Any type of counseling, cognitive-behavioural treatment, or psychotherapy that does not require hospitalization is explicitly stated in their policy as being excluded. In the case of National Insurance Company Limited, Alzheimer’s disease, dementia in Alzheimer’s disease, and Parkinson’s disease are permanently excluded if they present at the time of policy purchase.
“Many people are not aware that in order to claim their insurance, the patient needed to be admitted for at least 24 hours. Also, most of the time, banks reject the claims as their health conditions are associated with some pre-existing disorders. Therefore, one can only claim their insurance, if they have some new disease which is diagnosed only after they have taken their insurance,” an insurance broker, who wished to stay anonymous told The Sunday Guardian.
He also added, “It is true that insurance is a profit-making business as many brokers convince people to open health insurance at several places. On the other hand, they make people believe that they can claim their money from both places, however, that is completely against the law. Many people sometimes create false hospital bills and foolishly try to claim their money from two places. Since everything is online now, their details can be tracked, and then their claims get rejected.”
Mental illness requires not just medications, but also rehabilitation, psychotherapy, and counseling, all of which can put families in financial distress. Preexisting medical issues attract a premium loading from insurance carriers. As a result, Tatsam, a company is developing a one-of-a-kind mental health service, with a focus on working professionals. With the help of counselling and clinical psychologist training and mentorship programme, the company is to create a scientifically sound, evidence-based mobile mental health application that can be used alongside traditional therapy. Speaking of mental health, the CEO of Tatsam, Deepak Singh, told this paper, “Our primary goal was to help people understand that mental health is on par with physical health. Like with our physical health, if we don’t work on mental health, we will face issues resulting from mental unfitness. The product incorporates three main solutions – a program that builds long-term mental fitness, an immediate relief program that helps people in real-time and a superior network of trained, certified care providers that is personalised to each client.” At present, the company aims to examine the efficacy of smartphone-based therapies in conjunction with traditional therapy for three psychological disorders with significant global incidence rates: depression, anxiety, and affective disorders. The collection of data with an intention to eventually run RCTs on the application to assess efficacy and customer response, as finding quality, evidence-based apps remains a struggle.
Looking into the history of mental health insurance, India launched Ayushman Bharat PM-JAY in 2018, which covered treatment costs with pre-and post-hospitalization costs of mental disorders such as mental retardation, mental disorders-organic, including symptomatic, schizophrenia, schizotypal, and delusional disorders, neurotic, stress-related and somatoform disorders, mood (affective) disorders, behavioural syndromes associated with physiological disturbances and physical factors, mental and behavioural disorders due to psychoactive substance use. However, due to the high cost of therapy sessions with pre-existing diagnoses, obtaining mental health insurance remains a challenge for middle class people.