Which Hospital Covers Heart Surgery Under Insurance and Ayushman Card?

Hello,

Heart problems such as blocked heart arteries, valve problems, or certain congenital heart conditions can require procedures or surgery. The treatment depends on the diagnosis, severity of the blockage or valve problem, symptoms, and the cardiologist’s evaluation.

Common heart procedures include angioplasty with stent placement, bypass surgery (CABG), and heart valve surgery. The availability of coverage depends on the specific procedure and the hospital’s empanelment.

Hospitals Where Heart Treatment Can Be Done

For treatment, you can choose a hospital that is empanelled under Ayushman Bharat PM-JAY or a hospital that is included in your health insurance network, depending on the type of coverage you have.

For a private health insurance claim, the hospital should generally have a cashless tie-up/network arrangement with your insurance company or TPA. For Ayushman Bharat, the hospital needs to be empanelled under PM-JAY for the relevant treatment package.

What Is Covered Under Ayushman Bharat?

Ayushman Bharat PM-JAY provides coverage for eligible beneficiaries for various hospitalisation and surgical treatment packages, including several cardiac procedures.

The exact coverage depends on :

• The diagnosed heart condition

• The procedure required

• The applicable PM-JAY package

• Hospital empanelment

• Patient eligibility and scheme rules

Therefore, before admission, it is important to confirm that the specific heart procedure is covered at the selected Ayushman-empanelled hospital.

How to Check the Hospital Under Ayushman Bharat

1. Visit the PM-JAY Hospital Finder.

2. Select your State and District.

3. Select Cardiology / Cardio-Thoracic & Vascular Surgery (CTVS), as applicable.

4. Search for PM-JAY-empanelled hospitals.

What Is Covered Under Health Insurance?

If you have private health insurance, coverage for heart surgery depends on your policy. Depending on the plan, it can include hospitalisation expenses, surgery charges, ICU expenses, medicines, investigations, and other eligible treatment costs.

Before admission, check

• Whether the hospital is in your insurer's network

• Whether the heart procedure is covered

• Your sum insured

• Waiting-period conditions

• Any disease-specific exclusions

• Pre-authorisation requirements

How HexaHealth Can Assist You

HexaHealth is not a hospital. We have a network of partner hospitals and experienced doctors who provide treatment for different heart conditions.

HexaHealth can assist you with

• Finding suitable partner hospitals for cardiac treatment.

• Connecting you with experienced cardiologists and cardiac surgeons.

• Helping with appointment booking.

• Guiding you about the required cardiac tests and consultation.

• Helping you understand treatment and surgery options.

• Assisting with hospital coordination when surgery or admission is required.

• Providing guidance regarding Ayushman Bharat PM-JAY and health insurance-related hospitalisation processes, based on the applicable hospital and coverage.

If you share your city, heart problem/diagnosis, and whether you have an Ayushman Card or private health insurance, the suitable hospital options and coverage process can be explained more specifically.

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