Is Pericardial Surgery Covered Under Insurance?

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Health insurance might cover the pericardial surgery if your policy includes surgical treatment benefits and hospitalisation. But the coverage depends on the insurance company’s terms, pre-authorisation requirements, exclusions and waiting periods.


Pericardial surgery refers to the procedure conducted on the pericardium (the sac surrounding the heart). The surgery is usually recommended when medication alone is not enough to handle the condition. Read on to know more!


Understanding Pericardial Surgery


Pericardial surgery is used for treating conditions that affect the outer lining of the heart. Some of the common procedures include:



  • Pericardiectomy: This procedure is conducted to remove a portion or all of the pericardium in severe cases.

  • Pericardial Window Surgery: In this procedure, physicians create a small opening to drain the fluid.

  • Pericardiocentesis: Excess fluid around the heart is removed with a needle.


The type of surgery depends on the patient’s medical urgency, symptoms and condition.


What Conditions Might Need Pericardial Surgery?


Pericardial surgery might be recommended for several heart conditions, such as:



  • Recurrent pericarditis that does not improve with medications.

  • Constrictive pericarditis (thickening or scarring of the pericardium)

  • Cardiac tamponade (pressure on the heart caused by extra fluid)

  • Pericardial effusion (fluid buildup around the heart)


All these conditions can have an impact on how the heart functions and might need immediate treatment.


What Expenses Might Be Covered Under the Health Insurance?


If this surgical procedure is covered, the policy might include the following expenses:






























Expense Category



Might Be Covered



Follow-up hospital visits



Partially covered, subject to the policy



Surgeon’s fees



Yes, it is covered



Diagnostics and medicines



It is often covered



Operation theatre charges



Usually covered



ICU (Intensive Care Unit) charges



It depends on the policy



Note: The coverage limits might differ greatly across policy plans and insurance firms.


What Can Affect the Claim Approval?


Several factors can affect claim approval, including:



  • Whether the surgery is medically necessary

  • Submission of all the needed medical documents

  • Completion of the waiting period

  • Choice of a network hospital for the cashless treatment

  • Availability of pre-authorisation


It is advisable to review the policy terms carefully before hospital admission.


What Happens If the Claim Gets Denied?


A claim might get denied for the following reasons:



  • The treatment falls under the policy exclusions

  • The insurance firm determines that the process was not medically necessary

  • The required documents are missing

  • The insurance policy has lapsed


If this happens, ask the insurance company for an appeal or clarification as per the policy process.


Pericardial surgery can be costly because it usually involves specialised cardiac care. Having a good understanding of the health insurance coverage can help you lower the financial stress and allow proper treatment planning. The claim outcomes and coverage might depend on the medical underwriting and policy terms. Take a look at the policy details for the exact conditions.