Angioplasty claims soar under Medisep, treatment practices under scrutiny
A sharp rise in Medisep coronary angioplasty claims has sparked calls for an audit. While experts cite an aging demographic and cashless access, officials remain uncertain whether procedures were emergencies or manageable via medication.
A sharp rise in Medisep coronary angioplasty claims has sparked calls for an audit. While experts cite an aging demographic and cashless access, officials remain uncertain whether procedures were emergencies or manageable via medication.
A sharp rise in Medisep coronary angioplasty claims has sparked calls for an audit. While experts cite an aging demographic and cashless access, officials remain uncertain whether procedures were emergencies or manageable via medication.
Kozhikode: A sharp rise in coronary angioplasty claims under Medisep, the health insurance scheme for State government employees and pensioners, has raised questions over the growing use of the procedure, spurring calls for an audit of treatment practices at empanelled hospitals.
Between the launch of the scheme in July 2022 and January 2026, a total of 13,365 angioplasty claims were approved for treatment at government hospitals and private hospitals empanelled under Medisep, involving an expenditure of ₹120.76 crore. The available data, however, do not reveal how many procedures were performed as emergency interventions following heart attacks and how many were planned procedures that could potentially have been managed with medication.
From accounting for only a small number of claims in the initial months of the scheme, angioplasty made its way into the list of the 10 most frequently availed treatments under Medisep by December 2024. A total of 8,352 claims were recorded during the first two-and-a-half years of the scheme. The cumulative figure rose to 12,954 in 2025, with 4,602 claims registered that year alone, 1,261 more than in the previous year.
Angioplasty now ranks second among treatments, accounting for the highest expenditure under Medisep. It also has the highest average payout per claim, at ₹90,360.
Medisep has around 36 lakh beneficiaries, including government employees, pensioners and their dependants. There are growing calls for a comprehensive audit of angioplasty procedures at government and private hospitals to establish whether patients undergoing angiograms are advised to undergo angioplasty at significantly different rates in the two categories of hospitals.
The unusually high number of claims has prompted demands for an investigation. Health professionals, however, point out that a significant proportion of Medisep beneficiaries are above 50, an age group more susceptible to cardiac ailments, which could partly account for the rise. They also attribute the increase to the availability of cashless treatment under the scheme. Beneficiaries who earlier put off cardiac investigations and procedures, including stent implantation, because of the high costs may now be seeking treatment without delay, they said.