Enhanced External Counterpulsation, or EECP, is a non-invasive treatment that’s gaining popularity among cardiologists, especially for patients with chronic or refractory angina and certain types of heart failure. Despite its medical acceptance and effectiveness for selected patients, many policyholders may be surprised to learn that EECP is not covered under health insurance in India.
What is EECP Treatment?
EECP (Enhanced External Counterpulsation) is a non-invasive outpatient procedure where large cuffs are wrapped around the lower limbs and inflated and deflated in sync with the patient’s heartbeat. This helps improve blood flow to the heart and reduce angina symptoms without the need for surgery. EECP is generally prescribed for:
- Chronic stable angina or refractory angina – when chest pain persists despite optimal medical treatment.
- Heart failure, whether with reduced or preserved ejection fraction.
- Post-intervention recovery – Some patients who continue to experience symptoms even after angioplasty or bypass surgery are referred for EECP.
This treatment can provide relief from symptoms and improve quality of life in selected patients who are either not suitable candidates for surgery or prefer non-invasive options.
Is EECP a Medically Approved Treatment?
Yes, the clinical effectiveness of Enhanced External Counterpulsation (EECP) is well supported globally. It is a recognized non-invasive treatment that has received approval from major regulatory and medical bodies. In the United States, the Food and Drug Administration (FDA) has approved EECP for the treatment of conditions such as angina and heart failure. Its efficacy is further backed by clinical trials, including the widely cited MUST-EECP trial (Multicenter Study of Enhanced External Counterpulsation), which has demonstrated positive outcomes in suitable patient groups. Moreover, EECP is included in the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines for specific patient profiles. These endorsements clearly establish that EECP is not an experimental or fringe therapy; rather, it is an evidence-based, accepted treatment option within the scope of contemporary cardiology practice.
Hospitals in India that where EECP is available
EECP is mainly available in a number of physiotherapy centers across India. However, still not mainstream across all hospitals, EECP is available in reputed cardiac centers such as:
- Asian Heart Institute, Mumbai
- Apollo Hospitals (selected branches)
- Chettinad Hospital, Chennai
- Frontier Lifeline Hospital, Chennai – among the early adopters of EECP in India
The procedure is generally done on an outpatient basis in a cardiac or vascular unit.
Why is EECP Not Covered under Health Insurance?
This is a very common and valid question. If the treatment is medically approved, why is it excluded from insurance? To understand this, we need to look at how health insurance policies define covered treatments, especially day care procedures and OPD (Outpatient Department) procedures.
What is a Day Care Procedure?
The IRDAI (Insurance Regulatory and Development Authority of India) defines Day Care treatment as:
Medical treatment, and/or surgical procedure which is:
A. Undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs. because of technological advancement, and
B. Which would have otherwise required hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.
Insurers may further restrict coverage to a specific list of approved day care procedures, usually mentioned in the policy wording.
Why EECP is Not a Day Care Procedure?
EECP does not meet the IRDAI definition of a day care procedure due to the following reasons:
- Non-invasive: There is no incision, surgery, or internal intervention.
- No anesthesia: The procedure does not require general or local anesthesia.
- No hospitalization: It is done in an outpatient setting and doesn’t need admission.
- Performed in non-hospital centers: Many EECP centers are not registered hospitals as per IRDAI norms.
As a result, it doesn’t qualify as a day care treatment under standard health insurance policies in India.
So, Under what category does EECP fall in insurance terms?
EECP is considered as an OPD (Outpatient Department) procedure.
- It is performed outside hospital admission.
- Usually done in sessions – 1 hour per day for 5–7 days a week over 6–7 weeks.
- The patient walks in for the session and leaves right after, without any admission or observation period.
Most retail health insurance plans in India do not cover OPD treatments, unless the plan specifically includes an OPD benefit.
What Do Health Insurance Policies Say About EECP?
Most health insurance policies include a general clause for exclusions. One of the commonly found standard wordings is:
“Any treatment received outside the scope of hospitalization or listed day care procedures is not covered under the policy.”
Some insurers explicitly list EECP under policy exclusions, while others exclude it indirectly by denying OPD treatments.
So even though EECP has therapeutic value, it is not covered due to the type and setting of the treatment.
Can OPD Coverage in a Health Insurance Policy Help?
Yes, some comprehensive or premium health insurance plans now come with an OPD cover add-on. This may include expenses related to:
- Specialist consultations
- Diagnostic tests
- Pharmacy bills
- Minor treatments in OPD settings
But even here, most insurers do not cover EECP under OPD reimbursement, unless specifically stated. Always check the policy document or consult with your insurance provider before starting such treatments.
Is There a Way to Get Insurance Coverage for EECP?
Currently, under IRDAI regulations and insurance market practices in India, there is no mandatory requirement for insurers to cover EECP. The only possibility of coverage could arise from:
- Corporate group health insurance – Some employer-based group covers may reimburse OPD or alternative procedures.
- Customized products – Future products or plans that are tailored for heart patients or include OPD riders may cover EECP if demand rises.
Final Thoughts: Should EECP Be Covered?
From a medical standpoint, EECP has proven helpful in selected heart conditions. It is non-invasive, carries minimal risk, and can improve quality of life.
But from an insurance coverage point of view, EECP doesn’t fit into the structure of hospitalization-based reimbursement which most Indian health insurance plans follow. Unless health insurance products evolve to offer broader OPD or non-hospital-based care coverage, EECP is likely to remain excluded.
