Angioplasty: Insurance cover allegedly fuelling unnecessary procedures, stent commission deals

THIRUVANANTHAPURAM: Allegations have emerged that insurance coverage is prompting some hospitals to perform angioplasties even when they are not medically necessary, particularly on patients who experience minor chest pain. Because patients can claim these costs from their insurance, they often avoid the financial burden themselves. Hospitals reportedly inform patients that an angioplasty is urgently needed, outline the associated costs, and emphasise the necessity of a stent to address a blockage in the heart. They may also recommend higher-priced stents while highlighting their benefits. Once patients are assured that these expenses can be claimed through insurance, they are more inclined to agree to the procedure since they do not have to pay out of pocket.

Insurance companies assess claims for angioplasty by reviewing medical reports to determine the necessity of the procedure. However, it has been alleged that some claims are approved through collusion with hospitals. Meanwhile, some insurers are said to examine such claims very closely.

Commission deals over stents

Commission arrangements are also reportedly influencing the choice of stents used in angioplasty. Allegedly, stent manufacturers are incentivising doctors to recommend higher-priced products by offering gifts, sponsored trips, and event sponsorships. The more expensive the stent, the larger the reported incentives. As a result, patients who may not actually need angioplasty are being fitted with costly stents, further increasing their hospital bills and financial strain.