Are heart bypass surgery and stents covered under Ayushman Bharat?

Dear Raj Kumar Ranjan ji,

Yes, Ayushman Bharat PM-JAY covers several cardiac procedures under its approved health benefit packages. The PM-JAY package structure includes both Cardiology and Cardiothoracic & Vascular Surgery (CTVS) specialties. 

However, there is an important distinction: having undergone a bypass surgery or stent procedure in the past does not mean that every future heart-related treatment will automatically be covered. The specific procedure must be included in the applicable PM-JAY package and the hospital must be empanelled for that speciality/procedure.

What Cardiac Treatment Can Be Covered?

Depending on the patient's diagnosis and the applicable package, PM-JAY includes various cardiac procedures, such as

• Certain angioplasty/vascular procedures

• Stent-related procedures where covered under the applicable package

• Pacemaker implantation

• Cardiac catheterisation and other interventional procedures

• Cardiothoracic and vascular surgical procedures

• Treatment for certain cardiac emergencies

The official National Health Authority package documents specifically list Cardiology and CTVS procedures and indicate that pre-authorisation is mandatory for the CTVS packages.

What About Treatment After a Previous Bypass?

If the patient has already undergone CABG/bypass surgery and now needs another heart procedure, the previous bypass itself does not automatically exclude the patient from PM-JAY.

For example, depending on the current medical condition, a patient may subsequently require

• Repeat cardiac evaluation

• Angiography

• Angioplasty/stent

• Treatment for graft-related problems

• Another cardiac procedure or surgery

Whether the particular treatment is covered will depend on the doctor's diagnosis, the exact procedure and the applicable PM-JAY package.

The hospital also need to obtain pre-authorisation before proceeding with certain procedures. 

How to Check Whether Your Heart Treatment Is Covered

Before admission, follow these steps

1. Go to the official PM-JAY hospital search portal.

2. Select your state.

3. Select your district.

4. Search for the hospital by name.

5. Check that the hospital's PM-JAY empanelment is currently active.

6. Check whether Cardiology or CTVS is available.

What Documents Should You Carry?

Keep these documents ready

• Ayushman Card

• Aadhaar or other valid identification

• Previous bypass surgery records

• Previous angioplasty/stent records

• Current cardiologist's prescription

• Angiography report

• ECG/Echo reports

• Recent blood-test reports

• List of current medicines

• Previous discharge summary

These records are particularly important when the patient has already undergone bypass or stent treatment.

Important Precaution

If the patient currently has severe or new chest pain, breathlessness, sweating, fainting, severe weakness or pain spreading to the arm, shoulder, jaw or back, do not wait for routine Ayushman verification. Seek emergency cardiac care immediately.

Also, do not stop aspirin, blood thinners, cholesterol medicines or other cardiac medicines without the treating cardiologist's advice.

How HexaHealth Can Help

We can help you identify suitable partner hospitals and experienced cardiologists/cardiac surgeons, coordinate consultations and help you understand the Ayushman treatment process.

If you tell us the patient's current heart problem/procedure advised and city, we can guide you on what type of Ayushman-empanelled cardiac hospital you should look for and what exactly to confirm before admission.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth