‘If this was a normal person...’: Insurance row erupts over Saif Ali Khan’s 'swift' ₹25 lakh claim approval

The Association of Medical Consultants (AMC), representing 14,000 members, has called out the Insurance Regulatory and Development Authority of India (IRDAI) over what it terms “preferential treatment” for celebrities. Their grievance stems from the swift approval of a ₹25 lakh cashless treatment claim for actor Saif Ali Khan at Lilavati Hospital in Bandra last week.

According to AMC, the claim was sanctioned within hours—a speed unheard of for most policyholders. “In medicolegal cases, insurers typically require documents like an FIR, but this was waived, and the cashless claim was approved immediately,” said a senior surgeon.

Health insurance expert Nikhil Jha echoed AMC’s concerns, calling out the systemic inequity. “If this were any normal person, the company would have applied reasonable and customary charges and not paid the claim,” Jha said, adding that the preferential treatment raises critical questions about fairness in the system.

The AMC letter criticized what it called a “two-tier system” in India’s health insurance sector, where celebrities and corporate policyholders enjoy swift and large claim approvals, while ordinary citizens struggle with delays, low reimbursements, and capped benefits. “This trend undermines the principle of equitable healthcare access,” the letter read.

Doctors argue that approvals of this magnitude often take significantly longer for average policyholders, especially for complex cases. “Such a huge sanction and at that speed are rarely seen in the healthcare industry,” noted a senior doctor, emphasizing the disparity.

AMC’s Medico-Legal Cell head, Dr. Sudhir Naik, clarified in a ToI report, “We are not against corporate hospitals or celebrities. We want the same treatment for ordinary patients at nursing homes.” The association urged IRDAI to investigate the incident and reform the cashless approval process to ensure transparency and fairness.

Small hospitals and nursing homes, often unable to offer cashless facilities or forced to accept unreasonably low reimbursement rates, are losing patients to expensive corporate hospitals. “This practice is wiping out affordable healthcare options,” AMC warned.

The association’s long-standing demands include transparency in claim processing, equal access to insurance benefits for all policyholders, and support for nursing homes. “Health insurance should be a safety net for everyone—not a privilege for the few,” AMC emphasized.