A Lifeline for Your Heart: Ayushman Bharat
A diagnosis requiring heart surgery can be overwhelming, not just emotionally but also financially. The cost of procedures like bypass surgery or angioplasty can run into lakhs of rupees, pushing many families into debt. The Ayushman Bharat PMJAY scheme was created to address this exact problem. It provides a powerful safety net, ensuring that every eligible citizen can access life-saving cardiac care without worrying about the cost.
Yes, you read that right: major heart surgeries can be done completely **free of cost** under this scheme. This guide will explain which cardiac procedures are covered, what the treatment package includes, and the exact step-by-step process to avail this benefit.
Which Heart Procedures Are Covered by Ayushman Card?
The Ayushman Bharat scheme includes a comprehensive list of Health Benefit Packages (HBPs) for cardiology and cardiothoracic surgery. The ₹5 lakh cover is designed to handle even the most complex and expensive treatments. Some of the major covered procedures include:
- Coronary Artery Bypass Grafting (CABG): Commonly known as bypass surgery, this is a major operation to improve blood flow to the heart and is fully covered.
- Angioplasty (PTCA): This procedure, used to open blocked arteries, is covered. Crucially, the cost of the **stent(s)** used is also included in the package.
- Valve Replacement Surgery: The scheme covers both single and double valve replacement surgeries.
- Pacemaker Implantation: The entire cost of the pacemaker device and the implantation surgery is covered.
- Treatment for Congenital Heart Diseases: Procedures for correcting heart defects present from birth, especially in children, are included.
- Emergency Management: Treatment for heart attacks (Myocardial Infarction) during hospitalization is also covered.
What's Included in the "Free" Treatment Package?
When a hospital says the treatment is "cashless," it means the entire hospitalization is covered. As per the National Health Authority guidelines, the PMJAY package for a heart surgery includes:
- Registration and Bed Charges (General Ward or ICU).
- All consultation, surgery, and anaesthetist fees.
- Cost of implants like stents, pacemakers, or valves.
- All required medicines and drugs during the hospital stay.
- All diagnostic tests (blood tests, ECG, ECHO, X-rays, etc.).
- Food for the patient during their stay.
- Follow-up care and medicines for up to 15 days after discharge.
Step-by-Step Process for Cashless Heart Surgery
To ensure a smooth experience, follow this process:
- Step 1: Get a Confirmed Diagnosis
First, consult a qualified doctor and get a confirmed diagnosis that necessitates heart surgery. Get this in writing on a prescription.
- Step 2: Find the Right Empanelled Hospital
This is a critical step. You must find a PMJAY empanelled hospital that has a **Cardiology or Cardiothoracic Surgery department**. You can find the list on your state's page or check our guide on how to check the hospital list.
- Step 3: Visit the Ayushman Mitra Desk
Go to the selected hospital and head straight to the Ayushman Mitra helpdesk. Present your Ayushman Card, Aadhaar Card, and the doctor's diagnosis.
- Step 4: The Pre-Authorization Process
The Ayushman Mitra and hospital staff will verify your identity and submit an online pre-authorization request for the required heart surgery package. This request is sent to the insurance company for approval, which is usually granted within hours.
- Step 5: Receive Free and Cashless Treatment
Once approved, the hospital will admit you and proceed with the treatment and surgery. You will not have to pay for any covered part of the treatment.
Frequently Asked Questions (FAQs)
Q. Can I choose any stent or pacemaker?
The government has approved specific types and brands of stents and implants that are to be used under the scheme to ensure quality and control costs. The hospital will use one of these approved devices, and its cost is included in the package.
Q. What if the hospital asks me to buy expensive medicines from outside?
This is not allowed. All required medicines and consumables during your hospital stay must be provided by the hospital and are part of the cashless package. If a hospital asks you to buy them, it's a violation. You should immediately learn what to do if a hospital denies benefits and file a complaint.