Manas Sharma, a multinational IT professional, is one of many who had to work full-time at home as a result of a pandemic. Ergonomics with poor posture and little exercise have always caused back pain. He wanted to meet a doctor and a physiotherapist, but like many others, he was reluctant to venture into the hospital in the second wave of pandemic rage. He decided to choose home physiotherapy and has made considerable progress since then. Rs is insured even though the company offers group and personal health insurance. At 100,000 rupees, he still had to pay for physiotherapy from his pocket.
Could his insurance cover this cost? Does the insurance company pay for home medical care? The answer is a qualified “yes”. However, the challenge is that most people are unaware of the home care services covered by health insurance.
Before we dive deeper into insurance and home care, let’s understand what has changed in the home care market.
The traditional image of home care that many of us are involved with is that a doctor or nurse visits an elderly family member to provide home care. Home care was once dominated by unorganized mom and pop players with unstandardized procedures. Over the last decade, home care has seen some fundamental changes. The sector is flooded with professional home care players focused on providing organized, process-driven, customer-centric services. Much emphasis is placed on following clinically-led protocols, hiring professional and trained clinicians, and following a patient-centric approach. For example, at Nightingale, all clinicians and caregivers involved in a patient’s care plan are validated at multiple levels for educational qualifications, experience, and background, including police validation and infectious disease health. Clinicians are rigorously trained in clinical and working skills for globally recognized standard therapies. This ensures that the staff servicing the patient is not only at work savvy, but also safe for the patient and family. From home intensive care setup to remote consultation, postoperative care to blood sample collection, home care has evolved to meet the changing needs of consumers. According to a Redseer Consulting report, India’s home care segment will grow at 15-19% annually, reaching $ 11-13 billion by 2025 (from the current $ 5.4 billion). The Covid-19 pandemic is pushing this demand even further.
The Covid-19 pandemic has changed not only people’s perceptions of home care, but also the industry. Until recently, insurers recognized home care as a poorly organized market and preferred to move away from it. However, the second wave of pandemics shows that the need for home care services is increasing due to lack of beds and other necessary medical services. Recently, many insurance companies are paying for home medical care. Insurance companies have found that the home care model is effective in treating patients safely at home, while at the same time reducing billing from average Rs. 1.1 Easy for covid-related hospitalizations up to about rupees. 15,000 / -For Covid Home Quarantine Program.
Home care and insurance
If home care services are prescribed by a doctor or are an extension of an inpatient episode, most such services at home will be covered by the insurance company.
Home medical services covered by insurance can be broadly classified into the following three buckets.
When the medical care that is normally done in the hospital is done at home, it is called home care. This usually happens when the patient is not available for hospitalization or when the bed is not available and the patient cannot go to the hospital. The lack of beds during the second wave of the pandemic is one such scenario. In such cases, home treatment is a viable option.
Before and after hospitalization
Most insurance companies usually cover medical expenses before and after hospitalization. The coverage period before and after hospitalization may vary from insurance company to insurance company. During Covid-19, IRDAI instructed all insurance companies to cover pre-hospital care costs up to 15 days prior to hospitalization and home care, including diagnostic costs. Similarly, the insurance company was supposed to bear the medical expenses after hospitalization within 30 days from the discharge date or the end date of home treatment. An important point to note here is that home care costs incurred before and after hospitalization must be related to the illness that led to hospitalization.
Day care and OPD treatment
Not all medical procedures require hospitalization. Procedures such as hemodialysis and chemotherapy are day care procedures covered by insurance companies. Some insurance companies offer maintenance benefits in the OPD treatment category, such as long-term care, physiotherapy, doctor consultation, and home diagnosis.
The healthcare ecosystem consists of three major stakeholders: patients, providers and payers. Home care provides a mutually beneficial solution for all three stakeholders. It reduces the burden on India’s already overloaded healthcare system. Given the choices, many patients will prefer to recover from the comfort of their home with their loved ones. Not only does this help them recover faster, but it also significantly reduces costs. It will reduce the size of insurance claims. As the insurance and home care ecosystem matures, as has been done in the West, patients will be able to see more economical health care without compromising the quality of care. A truly exciting era is waiting for us!
Vaibhav Bhosale, COO, Nightingale Home Health Services
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Home Health Care and Insurance-What has changed in the last few years? , Health News, ET HealthWorld
Source link Home Health Care and Insurance-What has changed in the last few years? , Health News, ET HealthWorld