In the last, few years Indians have faced numerous challenges and difficulties on the health front. Ongoing pandemics and the risk of spreading infection have demonstrated that we need more and more healthcare options available at home. Another factor that is very important and a need of the hour is to have Cashless Treatment For Home Healthcare under health insurance plans.
The Power of Home Healthcare
The worst phase of the pandemic taught us how we can extend healthcare from hospital to home. Home healthcare service providers were the only hope when people were unable to get beds in the hospitals for the treatment of Covid-19. Imagine if someone wanted to get treated for other ailments, they might have faced intense trouble getting the admission and timely treatment for the problem.
In such situations, many home healthcare providers came forward to address the issue and open the gate to support patients at home. Max@Home a Unit of Max Hospitals is one of the leading home healthcare providers who took lead on this front and served many patients at home.
They started a Covid consult helpline, and home isolation service which includes online doctor’s consult, delivery of medical devices at home, lab sample collection, and medicine delivery at home. Max@Home was not the only home healthcare provider but many more who served society during that difficult time.
Change in Mindset and the Acceptance of Home Healthcare Space
Although, the pandemic has changed the mindset of people, healthcare providers, and health insurance companies, resulting in more acceptance of home healthcare services at home. Now the demand for Cashless Treatment For Home Healthcare under health insurance plans is increasing and customers want to opt for such health insurance policies and health insurance plans.
This was the reason, Insurance Regulatory and Development Authority (IRDA) released a notification to life insurance companies to provide home treatment. According to IRDA, homecare treatment is one taken at home for a disease or ailment that needs normally hospitalization provided that the medical doctor recommends treatment at home; there is a continuous active line of treatment with the health status of the patient is monitored by medical doctor daily during the duration of home treatment.
Also, these daily records of the patient getting treatment at home should be recorded and signed by a medical doctor.
Some insurance companies have started offering policies that do cover home treatment but are limited to a few ailments only, but cashless coverage is still a question for many. If your policy is not covering home treatment, it is useful to buy an add-on cover for the same.
What is the Current Situation of Insurance Cover for Homecare Services
Despite the IRDA notification, there is no desirable movement on this front and no insurance company is providing the cashless benefits for homecare treatment. The cashless benefit options were active during the Covid-19 pandemic only, and a fixed percentage of the policy sum insured amount was being paid to the patients for Covid-19 treatment at home. But there is no active movement seen on this front, few insurance companies are claiming to offer cashless benefits but there is no set procedure or process involved.
The Reality of Home Healthcare Insurance Coverage
Health insurance companies are giving these benefits under domiciliary hospitalization where the insured person is considered or treated as hospitalized even patient is at home. This is the feature of most Health Insurance Companies which was used to treat the patient were being turned away by hospitals due to a shortage of resources such as beds, oxygen cylinders, and other equipment during Covid-19.
But the irony is that despite domiciliary hospitalization coverage, patients cannot get the benefits of a cashless facility. Patients need to pay first from pocket to the healthcare provider and then go for reimbursement to the insurance company.
There are insurance companies offering health plans which have features of homecare reimbursement; some insurance companies offer it as an in-built feature and some provide it as an add-on feature.
When Domiciliary Hospitalization is Needed?
- The patient is unable to come to the hospital due to reasons such as existing comorbidities and risk to life.
- Despite all efforts, a hospital bed is not available as was faced during the Covid-19 pandemic
- When a doctor or medical practitioner recommends home care services instead of hospitalization
What is covered under Domiciliary Hospitalization?
- Cost of medicines
- Doctor’s consultation Fee
- Rental of medical equipment like oxygen cylinder
- Laboratory investigations
Apart from this Pre and Post hospitalization coverage also give the option to get the reimbursement for the treatment as per the policy terms. Generally, 30 days prior and 60 days after hospitalization expenses are reimbursed by the insurance company to the patient for the cost of medicines, consultation fees, and investigations.
What is the need for Cashless Homecare Benefits?
There is a big need to have cashless benefits available for homecare treatment also as patients get cashless treatment in the hospital. IRDA should come forward to give the benefits to the customers. Cashless benefits for home healthcare services will be a win-win situation for patients, healthcare providers, and insurance companies as well.
Benefits of cashless home treatment coverage to the Patients
- Fewer chances of exposure to nosocomial infections and hospital-acquired infections
- Faster recovery in the comfort of the home environment
- Palliative and terminally ill patients can be treated at home
- The cost of treatment at home would be lesser than the cost of treatment in a hospital
- The cashless cover would be easy for the old age patients
- Personalized care
Benefits of cashless home treatment coverage to the Healthcare Providers
- Better utilization of resources
- Availability of resources for critically ill patients
- Extended care to home and continuity of care
- The lesser burden on infrastructure
Benefits of cashless home treatment coverage to the Insurance Companies
- Lower cost treatment as room rent will not be the part of at homecare treatment
- Lower claim ratio
- A big customer acquisition opportunity
The most important benefit of a cashless home healthcare policy would be that patient can choose to continue the treatment in the comfort of home and does not need to get admitted to the hospital to become eligible to raise the claim.
This can be a future of Home healthcare services if Insurance companies, IRDA, and government bodies focus on the old age patients and the patients are undergoing palliative care treatment.