Latest news with #NABH-accredited
Mint
12 hours ago
- Health
- Mint
Why AYUSH claims keep getting rejected despite new insurance rules
Chhattisgarh-based Moin Vanak, who suffered from diabetes, hypertension, and poor digestion, turned to naturopathy for relief from persistent shoulder, knee and calf pain—as well as sleep issues. He got admitted for a 10-day in-patient treatment at a NABH-accredited facility, paying the expenses out-of-pocket despite having insurance, and later applied for reimbursement. Despite holding a valid policy, his claim was rejected. The insurance company said, "as per submitted documents, the patient was admitted primarily for diagnostic and evaluation purposes." Vanak has submitted his doctor's justification for why in-patient (IPD) care was essential, but the claim remains under dispute. "They are doing so even as the hospital is NABH-accredited," he said. As per the Insurance Regulatory and Development Authority of India (Irdai) directive issued in January 2024, all health insurance policies must cover AYUSH—Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy—treatments on par with modern medicine. While earlier policies included exclusions and sub-limits, insurers are now required to remove these. Yet, some exclusions remain. For instance, Star Health's comprehensive policy still excludes yoga and naturopathy. Niva Bupa's Reassure 2.0 plan also excludes yoga. Also read: Financial resilience: Why emergency funds are more crucial than ever Steep rejection rates Despite growing interest, many claims get rejected. 'We have spoken to a couple of AYUSH hospitals whose administration told us at least 70% insurance claims get rejected," said Shilpa Arora, co-founder & COO, Insurance Samadhan. Mumbai-based CA Mayank Gosar faced a similar situation. His parents, suffering from diabetes and digestive disorders, took a 7–8 day treatment at a NABH-accredited centre. 'There was substantial improvement in health post the treatment. They had taken panchakarma and detoxification therapies, full body acupressure, abdomen pack, neck pack, hydrotherapy and various other ayurvedic procedures," said Gosar. Gosar's mother's claim was rejected on grounds that the treatment didn't need hospitalisation. 'The doctor had clearly mentioned in the justification letter that staying in the AYUSH hospital for 7-8 days was medically necessary," he said. In his father's case, insurers kept asking for the same documents and have not processed the claim for over a year. Gosar has now approached the Insurance Ombudsman. Also read: Health insurance vs medical corpus: What should senior citizens prioritize? Faridabad-based Bhairav Vashishth's claim, initially rejected, was eventually accepted for cashless coverage. His daughter was undergoing treatment for morphea, a rare skin disease. 'After multiple rounds of back and forth and a justification by the doctor, the company accepted our request for cashless coverage," he said. What insurers say Insurance companies argue that AYUSH claims are treated like any other. 'We have observed a significant increase in the uptake of AYUSH treatments under health insurance. From FY24 to FY25, AYUSH claims rose over 30% and the amount paid grew around 48%," said Bhaskar Nerurkar, head - health administration team, Bajaj Allianz. A major challenge is the lack of standard treatment protocols. 'For the same condition, AYUSH medical management could differ greatly from allopathy. Sometimes insurers take an arbitrary stance on whether IPD was needed," said Sreejith Edamana, COO, Apollo AyurVAID. He added, 'More than 80% of our urban patients have insurance coverage, so it is critical to make the process seamless. Industry conversations to improve this are underway." Edamana also flagged CGHS pricing issues. 'Some insurers demand discounts on outdated CGHS rates last updated in 2016. This becomes a loss for everyone—patient, hospital, and insurer," he said. What patients should know Before opting for AYUSH treatment, confirm if your chosen hospital is in-network and NABH-accredited. Admission to an AYUSH hospital must be based on prior consultation and clear diagnosis by a recognised practitioner. Missing documents or unclear justification for hospitalisation often lead to claim rejection, said Bhabatosh Mishra, COO at Niva Bupa. 'You cannot simply go to an AYUSH center and get admitted. There must be a prior consultation with recognised AYUSH doctors and diagnostic reports justifying IPD treatment," he added. Hospitals must meet specific standards: at least five IPD beds, qualified practitioners available 24/7, and dedicated therapy sections. Mishra said that they have seen some AYUSH centers listed on travel aggregator websites offering a pleasant stay or organising an ayurveda retreat. "If you are a hospital treating ailments, how could you project yourself as a hotel?" he said. Also read: Life insurance is an interest area for us, says Star Health MD & CEO Anand Roy Also distinguish preventive vs curative care. 'Insurance covers treatment for disease, accident or infection. But preventive care—like managing blood sugar or BP without a formal diagnosis—may not be covered," said Bajaj's Nerurkar. Watch out for inconsistencies in hospital records. 'Sometimes the supervising doctor is qualified, but internal papers may mention someone else. That creates grounds for rejection," said Arora of Insurance Samadhan. As AYUSH gains ground, coordination between insurers and AYUSH hospitals is essential. Standardised packages and transparent billing could enable smoother, cashless claims. Curiously, even Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB-PMJAY), the government's flagship health scheme, is yet to include AYUSH treatments in its coverage. Also read: How corporate India is quietly becoming the health insurer for your parents
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Business Standard
a day ago
- Business
- Business Standard
Physis Capital raises ₹200 crore, eyes 15+ startup deals by mid-2025
Growth-stage venture fund Physis Capital on Wednesday announced that it has raised over ₹200 crore for its maiden fund. The fund, established by Vinay Bansal, Ankur Mittal, and Mitesh Shah of Inflection Point Ventures, plans to raise the remaining capital over the next six to nine months. The fund has attracted investors including SUD Life — a joint venture between Bank of India, Union Bank of India, and Japan's Dai-ichi Life Holdings. Other notable backers include Narayana Nethralaya, a NABH-accredited eye care institution in Bengaluru, and family offices such as Haldiram's and Lotus Holdings. Physis Capital plans to build a portfolio of over 15 companies by the first half of next year and aims to invest in high-impact, tech-driven startups in the pre-Series A to Series B stages. So far, the firm has eight deals in the pipeline and is preparing to issue term sheets for at least four of them in the coming months. These investments are expected to close within the next two quarters. The pipeline spans diverse sectors, including health-tech, fintech, consumer brands, and quick commerce, the company said in a statement. The cheque sizes for these companies will range between $1 million and $1.5 million, with a potential top-up of up to $4 million in high-performing portfolio startups. The firm has invested in three companies to date — Ben & Gaws, CTPL, and STAGE. Its most recent investment was in STAGE, a hyperlocal OTT platform creating content in Indian dialects such as Haryanvi, Rajasthani, and Bhojpuri. Vinay Bansal, general partner at the firm, said: 'With strong support from marquee investors and a clear focus on founder-first investing, Physis Capital is well-positioned to back the next wave of high-impact startups in India — partnering with bold, ambitious teams to drive long-term, sustainable growth. We are on track to build a portfolio of 15+ companies by the first half of next year.'
Time of India
12-06-2025
- Health
- Time of India
New dental & face surgery clinic opens at Pune's Inamdar hospital; to offer 24x7 trauma and implant care
Inamdar Multispeciality Hospital Elevates Emergency Care with New Dental & Face Surgery Clinic PUNE: In a significant enhancement to its comprehensive healthcare offerings, Inamdar Multispeciality Hospital (IMH), a NABH-accredited institution in Fatima Nagar, on Thursday announced the opening of its new Dental & Face Surgery Clinic. The facility was officially inaugurated and attended by prominent medical professionals and community leaders. This state-of-the-art clinic is designed to provide a full spectrum of dental, oral-maxillofacial, and periodontic care. Crucially, it is equipped to manage complex dental trauma and accident-related emergencies round the clock. By integrating surgical expertise, advanced imaging, and compassionate recovery support, the clinic aims to offer seamless, comprehensive care for patients facing critical facial injuries. The new unit will be led by a highly experienced team including Dr Rajat Bhende, MDS (OMFS), FHNO, Dr Priyadarshini Banerjee, MDS (OMFS), FFPS, and Dr Ritu Mathur, MDS (Periodontics). "Our vision for this centre extends beyond immediate care," stated Drs Bhende, Banerjee, and Mathur in a joint statement. "Over the next a few years, we aim for this facility to become Western India's primary referral hub for maxillofacial trauma, digital implantology, and facial reconstructive surgery. Through the introduction of 24-hour craniofacial emergency response, AI-guided treatment-planning, and fellowship-grade training programmes, we are committed to ensuring patients across Maharashtra can access world-class, research-backed care right here in Pune. "
India.com
10-05-2025
- Health
- India.com
Geopolitical Instabilities, VISA Denial Key Challenge For Medical Tourism In India: Expert
India's medical tourism sector is experiencing significant growth, positioning the country as a leading destination for affordable and high-quality healthcare services. In 2024, the industry was valued at approximately USD 7.69 billion, with around 7.3 million foreign patients seeking medical treatment in India. Projections indicate that the market could reach USD 18 billion by 2027, driven by factors such as cost-effective treatments, advanced medical technology, and government initiatives. Key Drivers of Growth "India offers medical procedures at a fraction of the cost compared to developed countries. For instance, a heart bypass surgery in India costs around USD 5,000, whereas the same procedure in the United States can cost approximately USD 123,000. This affordability, combined with a robust healthcare infrastructure featuring over 1,600 NABH-accredited hospitals and numerous JCI-accredited facilities, attracts patients from regions like West Asia, Africa, and South Asia," said Amit Bansal, Founder and CEO, Medigence. He said that government initiatives such as the "Heal in India" campaign and the introduction of the Ayush visa have streamlined visa processes and promoted traditional wellness therapies, further enhancing India's appeal as a medical tourism hub, but a lot is yet to be done. Challenges Facing the Sector Despite the positive trajectory, the medical tourism industry in India faces several challenges: Infrastructure Disparities: While metropolitan areas boast advanced medical facilities, rural regions often lack adequate healthcare infrastructure, leading to uneven service quality across the country. Regulatory Hurdles "Complex licensing procedures and inconsistent regulations across states can delay service delivery and deter investment in the sector. Then, there is VISA hurdles. Many a times, a patient gets visa but their family members don't get it and it creates a huge challege and an environment of deterrence," said Bansal. Geopolitical Instabilities: Political unrest in neighboring countries like Bangladesh, Pakistan has led to a significant drop in medical tourist inflow, highlighting the sector's vulnerability to regional conflicts. Quality and Safety Concerns: Inconsistencies in service quality and safety standards across different facilities can undermine patient confidence and Future Outlook To sustain growth and address existing challenges, India must focus on enhancing healthcare infrastructure across all regions, standardizing regulations, and ensuring consistent quality and safety standards. By leveraging its cost advantages and expanding its reach to new markets, India has the potential to solidify its position as a global leader in medical tourism.
