Does health insurance cover cardiac catheterisation?

Cardiac catheterisation is typically covered by health insurance if it is clinically required and recommended by a competent physician. Factors that might influence coverage include the nature of the procedure, insurance policy specifics, waiting period conditions, need for hospital admission, and performance within a network facility.

What Is Cardiac Catheterisation?

Cardiac catheterisation is a medical procedure done to diagnose heart conditions by looking at how the heart functions. The thin tube referred to as the catheter is inserted into the artery that leads to the heart for further inspection. This can be done by the doctors if they want to look for any blockage or abnormalities in the heart.

It may also be recommended prior to certain procedures like angioplasty and heart surgery.

When Health Insurance May Cover Cardiac Catheterisation

Most health insurance companies will usually cover cardiac catheterisation if the medical procedure is deemed necessary. Examples of situations where the coverage will be applicable include:

• Chest pain or heart disease


• Blockage or narrow arteries


• Abnormal blood flow to the heart


• Before heart surgery


• Any other cardiac emergencies

This particular medical procedure is usually covered under hospitalisation benefits.

Expenses That May Be Included in Coverage

Depending on the health insurance policy, the following costs may be covered:

• Doctor consultation charges during hospitalisation


• Diagnostic tests linked to the procedure


• Operation theatre charges


• Catheterisation lab expenses


• Hospital room rent within policy limits


• Nursing and medication costs


• Pre and post-hospitalisation expenses, if included in the plan

The exact extent of coverage depends on the sum insured and the policy wording.

Where Coverage Might Be Partial or Even Refused

There can be some instances where coverage for the claim might not be accepted or may be denied partially or completely. Such cases would include:

• The waiting period for preexisting conditions regarding the heart has not been completed.


• Procedure performed without a medical requirement.


• Heart conditions that have been excluded from the insurance plan.


• Failure to disclose any previous illnesses during the purchase of the policy.


• Excess costs above the room rent limit.

Also, there may be sublimits in case of cardiac problems.

Cashless and Reimbursement Claims

If the procedure is done at a network hospital, the insurer may offer a cashless claim facility. In non-network hospitals, the patient may need to pay the bills first and later apply for reimbursement by submitting medical records and bills.

Keeping documents such as discharge summaries, test reports, prescriptions, and hospital invoices is important during the claims process.

Important Things to Check Before the Procedure

Before undertaking a cardiac catheterisation procedure, it would be wise to check:

• Depending on whether the hospital is within the network of the insurance provider.


• The waiting period for heart ailments.


• Maximum ceiling for room rentals and treatments.


• Necessity for prior authorisation before treatment.

All coverage and payment for claims depend upon the policy wording, medical necessity, and the guidelines provided by the insurance company.