Isapre patients face coverage gaps for advanced heart procedures

Patients using private health insurance (Isapres) in Chile face significant barriers to accessing minimally invasive cardiovascular technologies that are already recognized by the public system (Fonasa).

Because certain advanced procedures lack specific codes in private insurance tariffs, patients may be forced to pay out-of-pocket or pursue legal action to receive coverage. These costs can exceed $20 million, and in some cases, reach over $40 million. Affected treatments include Transcatheter Aortic Valve Implantation (TAVI) and endovascular mitral valve repair using devices such as MitraClip. These technologies allow for the treatment of severe valvular diseases via catheters, avoiding open-heart surgery, which is particularly beneficial for high-risk or elderly patients.

Dr. Nicolás Veas, a cardiologist at Centro Médico Nueva Estoril, noted that the issue stems from the slow speed at which the private insurance system incorporates medical advancements, rather than a lack of scientific evidence for these techniques. Since 2021, Fonasa has utilized a mechanism called 'Ajuste por Tecnología' to provide additional payments for high-complexity therapies and devices.