The Association of Medical Consultants (AMC) has criticised the IRDAI for alleged preferential treatment in insurance claims for celebrities, citing the quick approval of a ₹25 lakh claim for actor Saif Ali Khan
Published Jan 29, 2025 | 7:00 AM ⚊ Updated Jan 29, 2025 | 11:00 AM
Saif health insurance
The Association of Medical Consultants (AMC), a body representing over 14,000 medical practitioners, has raised serious concerns over the Insurance Regulatory and Development Authority of India (IRDAI) regarding alleged preferential treatment in medical insurance claims to celebrities by the insurance company.
The controversy stems from the swift approval of a ₹25 lakh cashless treatment claim for Bollywood actor Saif Ali Khan, who was hospitalised after a violent stabbing incident on 16 January. The incident has sparked a debate on the disparity in healthcare access and insurance claim processing between celebrities and ordinary citizens.
Saif Ali Khan was admitted to Mumbai’s Lilavati Hospital after sustaining multiple stab wounds during a robbery attempt. Niva Bupa Health Insurance, his insurance provider, approved a cashless treatment claim of ₹25 lakh within hours of his hospitalisation.
What has drawn criticism is the fact that the company waived standard documentation requirements, such as an FIR copy, which is typically mandatory in medicolegal cases.
Health insurance expert Nikhil Jha highlighted the deviation from standard procedures, stating that such rapid approvals are rare for ordinary policyholders. While the urgency of Khan’s medical condition may have justified expedited processing, “IRDAI should answer why Niva Bupa gave preferential treatment to a celebrity and made it hard for normal people to get a claim,” Jha remarked.
The AMC has expressed dissatisfaction with the IRDAI, arguing that the incident exemplifies a troubling trend in the healthcare insurance sector.
In a letter to the regulatory body, the AMC stated, “This instance highlights a troubling trend where celebrities and high-profile individuals receive favourable terms and higher cashless treatment limits, while ordinary citizens struggle with insufficient coverage and low reimbursement rates.”
Dr. Sudhir Naik, head of AMC’s medico-legal cell, emphasised that the association’s concerns are not aimed at celebrities or corporate hospitals, but rather at ensuring equitable treatment for all policyholders. “Insurance should be a safeguard for all, irrespective of social status. Preferential treatment based on celebrity status creates a two-tier system, which is discriminatory against ordinary policyholders,” he said.
Nikhil Jha, an insurance expert, questioned preferential treatment given to Saif Ali Khan.
“Why was preferential treatment given to Saif Ali Khan? Apparently the Insurance company sanctioned 25 lakhs within a few hours to Lilavati hospital for the treatment of Saif Ali Khan. The normal process is to ask for an FIR copy in medicolegal cases. The insurance company waived this requirement and immediately approved the cashless request for 25 lakhs,” he said in a post on X.
“The final bill apparently 36 lakhs which was also approved. The surgery and stay for 4 days does not justify the huge bill and the prompt approval If this was any normal person, the company would have applied reasonable and customary charges and not paid the claim. IRDAI should answer why Niva Bupa gave preferential treatment to a celebrity and made it hard for normal people to get a claim,” he added.
🚨Association of Medical Consultants Mumbai writes to IRDAI
Why was preferential treatment given to Saif Ali Khan?
“Apparently the Insurance company sanctioned 25 lakhs within a few hours to Lilavati hospital for the treatment of Saif Ali Khan.
The normal process is to ask… pic.twitter.com/1QyPrTD8gM
— Nikhil Jha (@NIKHILLJHA) January 25, 2025
The AMC’s criticism is rooted in the stark contrast between the experiences of celebrities and ordinary citizens when it comes to insurance claim processing.
Speed of approval
Celebrities: Claims for high-profile individuals like Saif Ali Khan are often processed within hours. In Khan’s case, the ₹25 lakh cashless treatment claim was approved almost immediately after submission, bypassing the usual bureaucratic delays.
Ordinary policyholders: For regular claimants, the process is typically much slower. Insurers usually require extensive documentation, such as an FIR copy in medicolegal cases, before approving claims. This can lead to significant delays and complications in obtaining necessary funds for treatment.
Documentation requirements
Celebrities: In Khan’s situation, the insurance provider waived standard documentation requirements, allowing for rapid approval of his claim.
Ordinary policyholders: Regular claimants face stringent documentation demands. Missing even minor details can result in claim denials or delays, making it challenging for them to navigate the claims process during emergencies.
Claim amounts and coverage
Celebrities: High-profile individuals often have access to larger cashless treatment limits and more favourable terms. For example, while Khan’s initial claim was for ₹35.95 lakh, ₹25 lakh was approved quickly, reflecting a higher threshold of coverage available to him compared to typical policyholders.
Ordinary policyholders: Many average citizens struggle with lower coverage limits and reimbursement rates. Insurance companies may impose stricter limits on claims based on their internal policies, which can be significantly lower than those available to celebrities.
The AMC has raised alarms about the broader implications of this disparity, arguing that it fosters a two-tier healthcare system. “Such practices create an unfair disparity and undermine the very principle of equitable healthcare access, which should be the cornerstone of insurance services,” the AMC stated in its letter to the IRDAI.
The association has called for an investigation into the incident and urged the regulatory body to implement strict guidelines to prevent preferential treatment in the future. “There is a need for greater transparency in how insurance claims and cashless treatment limits are determined. Equal access to healthcare benefits should be a priority, with fair policies applied across all policyholders,” the AMC emphasised.
In addition to the issue of preferential treatment, the AMC has highlighted another pressing concern: the significant disparity in payment rates offered by insurance companies to small hospitals and nursing homes, compared to large corporate hospitals.
“While we understand the rationale of negotiated rates based on volumes and services, the current structure places small hospitals/nursing homes at a severe disadvantage, thereby impacting our sustainability and ability to provide continued care,” the AMC stated.
The association outlined the following consequences of this disparity:
Financial strain: Low reimbursement rates often fail to cover the operational costs incurred by small hospitals, which provide comparable medical services to corporate hospitals.
Quality of care: Inadequate reimbursements compromise the ability of small hospitals to invest in medical infrastructure and retain skilled professionals, thereby affecting the quality of care provided to patients.
Access to healthcare: Small hospitals and nursing homes cater to the middle and lower-middle class, providing quality care at affordable rates. The financial challenges due to low insurance payments threaten to reduce healthcare access for this demographic.
Risk of fraud: The AMC warned that ridiculously low rates offered to small nursing homes could encourage dangerous cost-cutting measures or even fraud to cover losses.
The AMC has urged the IRDAI to take immediate action to address these issues. Their recommendations include:
“We believe that addressing these issues is crucial to maintaining a balanced healthcare system that can cater to the needs of all citizens effectively,” the AMC concluded.
(Edited by Ananya Rao)
