The Challenge of Mediclaim Eligibility for BAMS and BHMS Doctors in Medical Treatments

The field of alternative medicine, particularly treatments provided by BAMS (Bachelor of Ayurvedic Medicine and Surgery) and BHMS (Bachelor of Homeopathic Medicine and Surgery) doctors, often encounters challenges when it comes to mediclaim coverage. This article explores the reasons behind these challenges and provides insights for patients and insurers.

Regulatory Recognition and Standardization

Regulatory Recognition: Many regions rely on allopathic medicine (Western medicine) as the standard for healthcare and insurance coverage. Insurance regulatory authorities primarily recognize allopathic degrees as the standard for medical treatment. BAMS and BHMS qualifications, which are based on alternative systems of medicine (Ayurveda and Homeopathy respectively), may not be included in standard health insurance policies. This exclusion poses a significant challenge for patients seeking coverage for BAMS and BHMS treatments.

Standardization: Unlike allopathic medicine, alternative medicine practices such as Ayurveda and Homeopathy often lack standardized protocols and guidelines. While these practices have been used for centuries, the absence of a standardized framework makes it difficult for insurers to evaluate the efficacy and safety of these treatments. This lack of standardization can lead to challenges in claim settlements and add to the complexity of insurance processes.

Policy Terms and Coverage

Policy Terms: The terms and conditions of health insurance policies are crucial in determining coverage. Many policies explicitly state that coverage is restricted to treatments provided by registered medical practitioners with a degree recognized by the Medical Council of India (MCI) or its equivalents in other countries. BAMS and BHMS qualifications may not fall under this definition, leading to treatments by these practitioners not being covered. Such exclusions create a gap between the availability of alternative medicine services and the reimbursement options available to patients.

Given the specificity required by insurance companies, individuals must carefully check the specific policy details and consult with their insurers to understand the coverage options related to alternative medicine treatments. This collaboration is essential for patients to determine which treatments are eligible for reimbursement.

Claim Settlement Issues and Verification

Claim Settlement Issues: Insurance companies face unique challenges in verifying the credentials and practices of BAMS and BHMS practitioners. The process of assessing the validity and appropriateness of these treatments can be more complex compared to allopathic medicine. This complexity can lead to complications in claim settlements, delaying reimbursement for patients.

Awareness and Acceptance: The level of awareness and acceptance of alternative medicine varies across different regions and healthcare systems. In some places, there is a growing recognition and acceptance of Ayurveda and Homeopathy, which may influence how insurance policies are structured. However, in other regions, these practices may still be viewed with skepticism, further limiting their acceptance in insurance policies.

Validity and Reimbursement for AYUSH Treatments in Registered Hospitals

While BAMS and BHMS treatments often face challenges, it is important to note that treatments under registered hospitals of the AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) ministry are eligible for mediclaim coverage. The AYUSH ministry has guidelines that ensure proper documentation and verification of these treatments.

Resources and Information: The AYUSH website provides detailed guidelines and resources that can help both patients and insurers navigate the reimbursement process for AYUSH treatments. These guidelines ensure that the services provided by these alternative medical practitioners are recognized and reimbursable under mediclaim policies.

In conclusion, while challenges exist, it is possible to secure mediclaim coverage for BAMS and BHMS treatments through careful policy review and understanding. Patients should consult with their insurers and refer to the AYUSH guidelines to ensure that their treatments are properly reimbursable.