The state has so far reported more than nine lakh Covid-19 cases and the pandemic has stretched the health expenditure of households, especially since the majority of it is out of pocket. Out of the few who have insurance, the claims of many patients are yet to be settled.
According to General Insurance Council data, Karnataka’s Covid-19 patients have so far raised 57,207 insurance claims amounting to Rs 893 crore. Out of these, 44,412 claims have been settled, which amounts to Rs 414 crore.
While 872 of these patients are already dead, 3,992 are under treatment, and 52,343 have been discharged. The average worth of a Covid patient’s claim in the state is Rs 1,56,087. The average worth of a settled insurance claim is Rs 93,246.
The families of 7% of those who died of Covid have raised insurance claims. As on December 5, a total of 11,846 patients had died in the state.
Doctor’s fees 25% of bill
Sanjeev Mysore, Convener, Project Jeevan Raksha, a public-private partnership which collaborated and analysed the data from the General Insurance Council, said, “Doctor’s fees alone constitutes 25% of the bill in Karnataka.”
Out of the claims received from the state, 10,174 claims are from Bengaluru alone which amounts to more than Rs 154.54 crore. Out of these, as many as 8,602 claims have been settled that amounts to Rs 80.72 crore. While 123 of these patients are already dead, 741 are under treatment and 9,310 have been discharged.
The General Insurance Council is an important link between the Insurance Regulatory and Development Authority of India, the country’s apex insurance regulatory body, and the non-life insurance industry.
However, Suvarna Arogya Suraksha Trust (SAST), under the state health department that implements Ayushman Bharat-Arogya Karnataka (AB-ArK), had different figures. It has 894 hospitals empanelled with it, providing Covid treatment. Out of these, 216 are government hospitals and 678 are private hospitals.
Dr Manjunath B, director, medical management, SAST, told DH, “We have so far approved pre-authorisations of more than 1.32 lakh Covid patients.” This amounts to more than Rs 614 crore. There are 16,113 packages under AB-ArK scheme.
Another SAST official said, “While we have paid more than Rs 209 crore, claims worth more than Rs 123 crore are pending and claims worth more than Rs 39 crore have been approved, but payment is in the pipeline.”