I have recently been advised to undergo peritoneal dialysis, which is done at home. However, my insurance provider has informed me that dialysis is only covered if done in a hospital, with a minimum of 24 hours of admission. This treatment is expensive and needs to be done every month. Will it be covered by my insurance policy? What is the right way to claim it?
– Name withheld on request
Peritoneal dialysis is a widely used home-based treatment for kidney failure, and is more flexible and convenient than traditional hemodialysis in a hospital. Recognising the importance of this treatment, the Insurance Regulatory and Development Authority of India (IRDAI) has issued clear guidelines stating that all health insurance policies covering dialysis must also include peritoneal dialysis.
Under the IRDAI guidelines, insurers cannot deny coverage for peritoneal dialysis if the policy includes dialysis treatment – irrespective of where it is conducted. Patients who have been advised peritoneal dialysis do not need to get hospitalised just to meet insurance criteria as the regulator mandates equal coverage for all forms of dialysis. This ensures that medical decisions are based on the patient’s needs rather than insurance limitations.
For you to successfully claim coverage for peritoneal dialysis, it is important you understand the policy terms. You should review your health insurance policy documents to confirm that dialysis treatments are covered. If there’s any confusion, contacting the insurer and specifically asking about peritoneal dialysis coverage can provide clarity.
Also, some insurance companies may require pre-authorisation before processing claims for home-based dialysis, so it is advisable to check for any such requirements beforehand.
To avoid claim rejection, patients should maintain proper documentation, including medical prescriptions, treatment plans, and receipts of expenses incurred.
Shilpa Arora is co-founder & COO at Insurance Samadhan.
