In recent months, a rising number of policyholders across India have voiced frustration over health insurance claims being denied for Ayurvedic hospitalisation, despite IRDAI’s directive mandating equal coverage for AYUSH and allopathic treatments. The issue has now become widespread enough to spark debate among healthcare experts, insurers, and patient advocacy groups.
While Ayurveda remains one of India’s most trusted healing systems, the way insurers view Ayurvedic hospital stays is very different from how they assess allopathic hospitalisation. And this difference is at the heart of the problem.
Why Insurers Are Reluctant to Approve Ayurvedic Hospitalisation Claims
1. The ‘Medical Necessity’ Doubt
Insurers frequently question whether a patient really needed to be hospitalised for an Ayurvedic treatment, or whether the stay resembled a wellness retreat. Conditions like joint pain, mild hypertension, stress and metabolic issues are often treated in Ayurveda, but insurers argue these may not justify in-patient admission.
2. Documentation Gaps
A major sticking point is documentation. Many Ayurvedic hospitals still do not follow the standard medical paperwork used in allopathy — detailed case sheets, diagnostic reports, treatment plans, and daily progress notes.
This gives insurers an easy route to deny claims: “insufficient medical records.”
3. Long Durations Raise Suspicion
Ayurvedic therapies like panchakarma often require long stays — 7, 14, or even 21 days. To insurers, longer stays translate to higher bills, which invites closer scrutiny. If the documentation isn’t airtight, the claim is at high risk of rejection.
4. Limited Empanelled AYUSH Hospitals
The number of AYUSH hospitals on insurance panels is still very small. Many claims come from non-empanelled centres, making insurers cautious about authenticity and treatment quality.
5. Regulation vs Reality
Despite IRDAI’s equality order, implementation has been slow. Insurers are still stuck in older frameworks where AYUSH treatments were considered “alternative” and therefore less rigorously recognised.
How Patients Can Improve Their Chances — and Actually Win Their Claims
Experts say Ayurvedic claims can be approved — but the patient must take a proactive approach.
✔ Choose an Accredited, Empanelled Centre
The safest option is to undergo treatment in a hospital already recognised by your insurer. Accreditation adds credibility and reduces disputes.
✔ Apply for Cashless Treatment First
Because Ayurvedic treatments are mostly planned, requesting cashless approval gives you early warning if the insurer needs extra documents. Even if cashless is denied, the insurer’s reasons can help strengthen your reimbursement claim.
✔ Keep Documentation Strong
Patients should ensure:
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Diagnosis clearly stated
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Doctor’s registration number included
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Treatment plan explained
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Progress notes recorded
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Justification for length of stay included
The more “medical” the paperwork looks, the smoother the claim process becomes.
✔ Avoid Wellness-Only Programs
Insurers draw a strict line between treatment and wellness.
Stays that appear like rejuvenation or spa-style retreats rarely get approved.
✔ Appeal if Rejected
Many claims approved in the second attempt succeed simply because the patient submits additional clinical proof.
If needed, the case can be escalated to:
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Insurer’s Grievance Redressal Officer
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IRDAI complaints portal
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Insurance Ombudsman
These channels often rule in favour of patients when evidence supports medical necessity.
A Slow Shift in Attitude
Industry observers say the rising demand for natural healing and the government’s strong push for AYUSH integration will force insurers to modernise their approach. But until hospitals upgrade documentation and insurers adapt their evaluation criteria, Ayurvedic hospitalisation claims will continue to face friction.
For now, patients can still win — but only if they understand the system and prepare well.