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Common questions

Angioplasty

This fact sheet is to help MBF members and their families be better prepared for the healthcare experience if they undergoing angioplasty.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and perhaps with other healthcare professionals in the team caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading will also help you make more informed decisions.

What is angioplasty?  

The heart is a muscle and although it is the pump that sends blood throughout the body, it too receives its oxygen and nutrients in its blood supply through several blood vessels that surround it, known as coronary arteries. Coronary artery disease is the condition that arises when these blood vessels that feed the heart are blocked, either by hardening (fibrosis) of fatty material that has accumulated along the walls of the coronary arteries (plaque) or by blood clots. If the blockage is severe, and blood flow is cut off for a significant time, heart cells that do not receive enough blood and oxygen will die (medically known as ischaemia). If enough damage occurs to the heart due to blockage of these arteries, a heart attack results (medically known as a myocardial infarction). Coronary heart disease is a term that includes the symptom of chest pain (medically known as angina), heart attacks, and sudden unexpected death (cardiac arrest).

Angioplasty is a surgical procedure that is used to widen a blocked coronary artery to allow more normal blood flow.

Angioplasty is generally very effective - in around 95% of cases it reduces the fatty plaque lesions successfully. As with any surgery however, there are risks. With angioplasty, these include perforation of the artery requiring emergency bypass surgery, artery spasm and possibly even heart attack, abnormal heart beat, stroke, allergic reaction, bleeding at the wound site, blood clotting and infection.

See 'Questions to ask your doctors' for more about this.

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Why is it performed?  

Generally, your doctor will recommend angioplasty if it has been determined that your artery is partially blocked by hardening (fibrosis) of fatty material that has accumulated along the walls of the coronary arteries, which is known as plaque and if there are concerns that it may eventually cause a heart attack.

Often, such a blockage in the artery will cause a symptom known as angina. Angina is a certain type of chest pain or tightness in the chest associated with insufficient blood and oxygen to the heart muscle and is often accompanied by symptoms that include breathlessness, pain in and around the neck, jaw or arms (especially the left arm), sweating or clamminess. It may also be associated with pain in the upper back and shoulders.

Untreated, angina may lead to a heart attack. Depending on the state of any blockage of the arteries and how effective medication might be, angioplasty is considered a less invasive alternative to open heart surgery, to open up the arteries and lower heart attack risk.

Thus, the idea of angioplasty is to re-open the parts of the specific arteries where damage has occurred most in order to reduce symptoms of ischaemic heart disease and also to reduce the possibility of heart attack. During angioplasty, a tube (catheter) is inserted into an artery, usually through the groin (or sometimes the arm). This is threaded through the blood vessels until it reaches the affected artery. A balloon at the end of the tube is then inflated, compressing the fatty plaque that is blocking the artery against the blood vessel walls and stretching the wall open.

Often, one or more mesh tubes called stents may be inserted to help hold the blocked part of the artery open even after the balloon and tube have been removed. This has become a common procedure.

Angioplasty is usually carried out using local anaesthetic and, depending on your health and other factors, generally involves either a day or overnight stay in hospital.

Stents  

If your specialist has recommended angioplasty (see above) the procedure may or may not include inserting stents into one or more of your coronary arteries. A stent is a wire mesh tube that is put in place to hold the artery open to allow blood flow. Read 'Questions to ask you doctors' to prepare for discussions with your specialist so that you feel you have made an informed decision regarding stents.

From a health cover perspective, a stent is a prosthesis. A prosthesis is a device that is surgically implanted during a stay in hospital. Read ' What MBF pays toward treatment' to better understand whether or not the charge for stents is paid under your cover.

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What is a prosthesis? Is this relevant to you?  

Your specialist may recommend surgery that includes inserting a stent, a pacemaker or implantable defibrillator (see 'Your treatment options'). Each of these is known as a prothesis. A prosthesis is a device that is surgically implanted during a stay in hospital.

This is important not only from a health cover perspective but because a prosthesis may wear out over time. If this situation is severe, it must be replaced by another prosthesis. Several factors will influence whether you could need a replacement in the future:

  • the quality of the prosthesis you receive;
  • your current health status and lifestyle behaviours;
  • personal factors such as obesity and your age; and
  • complications of surgery such as infection.

Read 'Questions to ask you doctors' to prepare for discussions with your specialist so that you feel you have made an informed decision regarding your prosthesis.

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Questions to ask your doctors  

Angioplasty is a specialised procedure that is usually and often best performed by a cardiac specialist (cardiologist) or surgeon who is highly experienced in angioplasty. A doctor who has performed many of these procedures with a very low complication rate is the best person for the job.

Your GP will generally suggest the names of one or more specialists and give you a referral for the procedure.

Some questions to ask your GP or referring doctor:

  • Why have you recommended this particular doctor? If I need angioplasty do you know if this doctor performs many of these and has had good results?
  • Do you know how many angioplasties this doctor may have done? How many does he or she do each year?
  • Does this specialist do these procedures at a hospital with nearby cardiac surgical facilities in case of problems? Is that an issue?
  • Do you know if he or she charges a 'gap' that Medicare or my health fund won't cover? Or is there someone just as suitable that is more likely not to charge a 'gap' over the medical fee? Even so, choose your doctor first based on their experience and expertise.

Some questions to ask the cardiologist or surgeon:

  • Why am I having angioplasty? What other options are there, and are there particular advantages or disadvantages, or greater or lesser risks, with any of those other options?
  • How is it likely to affect any pain, shortness of breath or tiredness that I have been suffering and how will it affect the possibility of having further heart problems in the future?
  • How long do you expect me to be in hospital?
  • Do I require stent(s)? If yes,
    • Is the stent you intent to use considered a 'no-gap' prosthesis? A small number of the prosthesis implants can have an associated out-of-pocket charge, but these are almost always limited to those where a similar no gap item is available.
    • If my stent requires a gap, what is the 'gap' and is there a comparable stent that is a no-gap prosthesis? If not, can you explain why?
  • What are the possible complications and/or side effects associated with my surgery?
  • What can I do, prior to hospital, to reduce my risk for complications?
  • Discuss healthy weight, appropriate exercise, how to quit smoking and/or your current medications with your doctor. If you are diabetic, well-managed diabetes prior to your surgery will also help your recovery.
  • Should I stop taking any of my medications prior to going to hospital? If so, how long before?
  • What is my expected recovery time?
  • How long after the procedure will it take to feel back to normal?
  • What restrictions will I have regarding my everyday activities when I go home (such as exercise and other activities, driving or lifting heavy objects)? If so, how long am I likely to need assistance?
  • Do you charge a gap that Medicare or my health fund won't cover? Even so, always choose your doctor/s first based on their experience and expertise.
  • Does the anaesthetist or any other doctor who may assist with the procedure charge a gap? If so, how much should I expect that to be?

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What MBF pays toward treatment  

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect in terms of your health cover, hospital and medical costs. Always check with MBF before you go to hospital.

Your hospital costs 

MBF Advantage Hospital, MBF Premium Hospital and MBF Standard Hospital cover will help pay for angioplasty surgery and/or stents provided that:

  • you have the procedure while you have been formally admitted in a hospital;
  • it is a treatment for which Medicare pays a benefit;
  • it is not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

MBF hospital cover will pay for the following treatments and services so long as you are formally admitted to the hospital and the above conditions are met:

  • shared accommodation (or private room if available);
  • surgery- related expenses including operating theatre and intensive care if needed;
  • certain therapies such as cardiac rehabilitation, physiotherapy and occupational therapy when provided by the hospital and associated with your hospital treatment;
  • certain drugs supplied as part of your inpatient hospital treatment; and
  • the full cost of a government-approved surgically-implanted prosthesis selected from the 'no-gap' list developed by the Department of Health and Ageing. Visit here for more about prostheses and your health cover.

Please note that cardiac procedures, including those associated with coronary artery disease, are Excluded services under MBF Budget Hospital cover. This means no benefit will be paid by MBF under this level of cover for hospital and doctors' charges associated with that admission, including coronary surgery and stents.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that the surgeon's and other doctors' charges will be part of your medical costs. In addition, Medicare pays a Medicare benefit toward out-patient cardiac rehabilitation.

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Your prosthesis costs  

Stents, which may be inserted during angioplasty, are prostheses. Should your specialist or surgeon feel one is necessary, you should have one or more prostheses available to you at no gap. The cost of a no-gap prosthesis will be fully covered by your MBF hospital cover so long as you hold an appropriate level of hospital cover and standard conditions are met. These conditions include waiting periods, any known Excess or Co-payment and any applicable Exclusions on your level of cover.

In a small number of cases, there may be other more expensive stents that your surgeon or doctor may recommend that could attract a gap. Where your surgeon recommends a stent that attracts a gap and you agree to that stent, you will have to pay a gap amount. Ask your surgeon to explain why he or she is recommending this particular stent over one without a gap.

If applicable, when and where to pay your prosthesis gap

When you are admitted to hospital for surgery, the surgeon should have made the hospital aware that a gap-prosthesis will be used for your procedure. The hospital will often ask you to the pay the prosthesis/device gap payment when you are admitted to hospital.

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Your medical (doctors') costs  

If you will be going to hospital and/or having surgery, ask your doctor/surgeon to explain the costs of your admission and/or surgery, including any prosthesis/device gap amount, their own fees, any fees that other doctors involved in the surgery might charge and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as informed financial consent. Obtaining this information is extremely important before any planned hospital admission.

Remember, there may be more than one doctor involved in the procedure. These may include the cardiac surgeon, an anaesthetist and an assistant surgeon. You may not meet them all in person.

Each doctor will charge for his or her services. See Going to hospital and Gap and informed financial consent for a guide to these costs.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no-gap' doctors or call MBF on 131 137.

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Other costs relating to your treatment and recovery  

Depending on your level of MBF extras cover, MBF can also help with the cost of:

  • dietetics provided by a Registered Dietitian to help establish good eating habits;
  • complementary therapies such as therapeutic massage;
  • pharmacy including most prescribed non-PBS listed medications, and
  • gym membership fees and other activities such as yoga through MBF Living Well Programs cover (restrictions apply).

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

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More about angioplasty and related conditions 

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More about going to hospital, MBF Network hospitals, no-gap doctors, and MBF MemberCare providers  

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 06-06-07

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