Updated: Mar 16
Surprise. It's Angioplasty. (and other invasive treatment for coronary artery).
A question that I’ve addressed for the last few years is in relation to whenever one of my clients thoroughly goes over the Critical Illness list.
Rather than just accepting that this is the standard across the board, occasionally I get an especially concerned mother or a snarky fellow who asks me WHY this is the case.
I typically refrain from saying ‘Do I look like an insurance company to you?’ and try to give a limited answer based on my research.
After all, as an Early Critical Illness Insurance specialist, I have at least a limited familiarity with each of the 36 LIA-approved Critical Illnesses.
[The 37th is Terminal Illness (TI), for the especially critical people reading this. There are no early or intermediate stages for TI – as a result, I often just leave it]
But I’ve always been curious about this.
What about it makes it so special?
Why is it 10% across the board, or if you’re fortunate enough, listed as a special condition where it doesn’t pay out of the original sum assured? (of which I sell proudly).
The Pain: Clogged Arteries
We’ve all heard of clogged arteries, especially when our parents (well mine anyway) are telling us to eat more vegetables and less fast food with saturated fats. Even the non-fast food favorites in Singapore tend to have oil or deep-fried variations.
As a result, heart disease and cancer typically fight it out for the number 1 killer in Singapore.
Closer to heart disease are clogged arteries – where the arteries in your heart are basically blocked up by plaque. Plaque is basically a fatty, waxy substance that hardens over time – and in a large enough quantity, it can block blood flow to particular areas of your body.
If oxygen can't get around your body, well. You die.
The most commonly known effect for this is simple - A large enough block:
1) Creates a blood clot;
2) Which creates a rupture;
3) Which causes a stroke.
The Treatment: Angioplasty (and Other Invasive Treatment for Coronary Artery)
Even prior to a serious Critical Illness like Heart Disease, or a Stroke or Heart Attack, there are usually some prevailing symptoms of clogged arteries like regular chest pain, bouts of dizziness, etc.
At some point, ideally during a medical examination that you would take instead of stubbornly insisting on leaving it be - a simple Electrocardiogram (ECG) will reveal the extent of the damage.
I've spoken a little about this in the link below, as well as some of the other critical illnesses you may not have known about.
This is where Angioplasty comes in.
Angioplasty is a procedure used to restore blood flow to your artery. It’s a simple three step procedure:
1) The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery.
2) The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery.
3) This widens the artery and restores blood flow.*
So if you ever wondered why you can only claim 10% of your entire sum assured (or worse, with a $20,000 cap), here are a couple of reasons.
The most prevalent reason for its cap on payments is because this procedure is already common and increasingly common – certainly far more than the standard cancers and heart diseases.
Even individuals who have led intentionally healthy lives have a significant build-up of plaque over the age of 65, which is when many of these claims are made.
Improving blood flow via procedure is also used for both purposes:
a) Pre occurrence – to prevent a stroke (or other related illnesses) in future
b) Post occurrence – having experienced a stroke (or other related illnesses) already, to prevent future incidences
The decision is made carefully by licensed medical professionals, of which I am not – but depending on the person’s health, the doctor can diagnose for it to be used regardless of the prior circumstances behind it.
2) Less Invasive
While still technically considered ‘invasive’ by the definition of the word, Angioplasty does not involve surgery.
Since heart disease happens more in old people (Age 65 or above) and there are no major incisions made into the body, it’s also a preferred treatment for risk.
Naturally, such a treatment has a higher preference, and hence a higher potential claim rate.
There are even less invasive procedures, but they may not be as widespread or more expensive – which is also another reason why some people purchase large quantities of Critical Illness Insurance so that they can expedite (hasten) or specialize their treatment (e.g. less invasive).
3) Quick Procedure, Quick Recovery
As noted above, Angioplasty is a fairly quick procedure (takes no more than a few hours) from start to finish.
After a day of monitoring overnight, many people go home the day after the procedure and if there are no further reported complications, can even return to work within a week.
Severe Critical Illnesses such as Cancer typically impede your ability to work effectively between 3 to 6 years. Comparatively, this works out pretty well compared to the former.
Ultimately, high preference and usage keeps the rate of claims high, and I wouldn’t think that an insurance company can afford to keep up with such costs.
What’s the Catch?
Even with a proper stent, statistically there is a 10% chance or so that you may need to take a repeat procedure. Without a proper stent, that number goes up to 30%.
If it gets bad enough, you may have to do a repeat procedure, or…
b) Further surgery
Unsuccessful angioplasty also means you might have to undergo a surgical procedure called Coronary Artery Bypass Surgery.
This is a common surgery opted for in late stage coronary artery issues.
In your insurance policies, a common definition amongst all the companies is as below:
"The actual undergoing of open-chest surgery or Minimally Invasive Direct Coronary Artery Bypass surgery to correct the narrowing or blockage of one (1) or more coronary arteries with bypass grafts.
This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist. Angioplasty and all other intra arterial, catheter based techniques, ‘keyhole’ or laser procedures are excluded."
In a bypass, an artery or a vein is removed from a different part of your body and sewn to the surface of your heart to take over for the blocked coronary artery.
This surgery requires an incision in the chest, and recovery from bypass surgery is usually longer and more uncomfortable.
Angioplasty is not foolproof, but it's common enough that more than 1/3 of you will likely have some kind of arterial treatment in your lifetime, and it's ideally not invasive.
The build up of plaque is really a precursor to the many, many different types of potential Critical Illnesses there are. In relation to arteries and heart disease, it takes up more than 20% of the Critical Illness list alone, and makes up a significant portion of the claims.
As a result, you really want to seek comprehensive coverage as well as policies that complement and enhance your existing coverage, since your claim on Angioplasty is capped.
There are a couple of ways you can get comprehensive coverage for heart related illnesses that come about from the build up of plaque.
One such way is with a solid, Early Critical Illness Policy.
Unlike a late stage policy, not only will you be able to claim for a much wider range of procedures such as Transmyocardial Laser Therapy instead of a invasive By-Pass surgery like the above, but you’ll also be able to claim 100% of the entire benefit rather than 10%.
For Angioplasty, a good Early Critical Illness policy will even cover it under it’s ‘Special Conditions’, where it will not be paid out from the main sum assured.
So let’s say I am insured for $250,000 of Early Critical Illness coverage and it is discovered I am at risk for a heart attack. The doctor advocates Angioplasty, where I get 20% of my benefit. [$50,000].
Subsequently, it turns out to not be enough and I require a proper surgery. I can get a less invasive Laser Therapy (as listed above), and still claim the full sum of $250,000 for a total of $50,000.
My hospital coverage should pay the majority of my medical bills, and with non-invasive surgeries detected early or upon diagnosis, I am able to return to work within a few weeks with a cool $300,000 in hand.
If someone my age paying monthly got a ECI after the 3rd month, I would have shelled out less than $1000 for that total sum assured of $300,000.
The money can be used for the following:
1) Treatment Variation: Less invasive treatments, better treatments, specialized treatments or faster treatments
2) Income Replacement: To make up for
a) how long a Critical Illness prevents you from working effectively, as well as
b) the opportunity cost that comes with it.
(B) is often overlooked, but in a fast paced 1st world environment like Singapore, a CI makes your skill set obsolete faster and you also aren't likely to increase your income value as quickly.
3) Specialized Equipment/Demand: E.g. Regular Private Transport, which I'm a big advocate for since most CIs will weaken your immune system to nothing. These are not things that your medical insurance will cover.
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National Heart, Lung and Blood Institute