3D coronary CT - covered by NHI?

Life Health & Fitness
#1

Hello everybody. Recently I’ve been checking my heart and as it turns out there are some problems with it. The cardiologist I saw yesterday strongly recommended me to do a “3D coronary CT”, with the aim of looking for possible “significant stenosis lesion”, or that’s what I understood. However I don’t know how much it is related to the 65-70% “possibility” of having “myocardial ischemia”, or perhaps with the “mild valve regurgitation”, both things diagnosed after doing a stress test yesterday.

So I guess I have the following questions, and hopefully someone knowledgeable in the matter can help a bit:

  1. the doctor said this is not covered by the NHI and that it costs around 20,000 NT. However he did strongly recommend it. Why is it not covered? does this change from hospital to hospital? maybe there isn’t solid enough evidence of me having that?
  2. the “65-70% possibility” of having “myocardial ischemia” means that I probably have it already, or that’s the chance of suffering it in the future?
  3. would the “myocardial ischemia” be confirmed by the “3D coronary CT”?
  4. can the “myocardial ischemia” be somehow related to the “mild valve regurgitation”? I understand that the latter is more like the valve getting stiff or something
  5. Is it recommendable to go to another reputable specialist?
  6. anyone help at all with this?

There’s more (a legal side) to this story but I want to keep the pure medical questions separated from that.

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#2

I’d suggest you take a second opinion from another doctor in another hospital. (Maybe in another city too if possible).

My rudimentary understanding is that if a doctor strongly recommends it, it should be covered by NHI unless there’s another cheaper alternative. The hospital may be avoiding telling you that to earn money.

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#3

It may be that NHI is paying a portion of it.

And for determining IHD it’s the gold standard.

#4

Sorry, I don’t know what you mean with this.

Edit: I’m guessing “Inherited heart disease”? No idea. I also don’t know what is the gold standard for determining IHD. You mean the 3D CT?

#5

Sorry if this sounds stupid, but I would really appreciate if people who reply do so to the numbered questions… that would help me a lot since I’m already very confused at the moment…

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#6

Cardiac catheterization is covered by NHI. For 3D CT covered by NHI, maybe there should be a reason you cannot take cardiac catheterization, or cardiac catheterization doesn’t work.

#7

Ischemic heart disease

#8

Any doctor in the room?

#11

A post was split to a new topic: Going private

#12

Your doctor who has seen you and is a cardiac specialist has told you what you need.

20,000nt is cheap. And NHI cover won’t vary from hospital to hospital. Not every procedure is covered by NHI , as I said what he has suggested is the gold standard to determine whether or not you have IHD.

Cardiac catheterization is also used to diagnose this. But is more invasive and not as accurate, and for multiple reasons may not give a complete diagnosis. So you may still require a CT scan after.

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#13

@riggers thanks for all your comments, much appreciated. Out of curiosity, are you a doctor or perhaps are you very familiar with all of this for some other reason?

#15

I was a radiographer so have done multiple CT scans , cardiac catheterisations etc over 20 years. When I finished I was mainly involved in neuro imaging , but covered everything on call etc

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#16

健保局同時將「非離子性對比劑」給付由原先的1500點降為920點，但因適應症放寬每年約增加健保支出1.8至2.8億元，本項修正公告後，凡符合下述適應症之民眾，其使用之非離子性對比劑均由健保支付，民眾可免除自費之負擔：

充血性心臟衰竭(NYHA心衰竭分期≧Ⅱ)、嚴重心律不整、惡性高血壓、不穩定性狹心症、心肌梗塞或肺高壓之最近病史或風險者
有重要器官衰竭者，如肝臟、肺臟、心臟、腎臟
腎臟功能不全者(Creatinine >2mg/dl)
氣喘急性發作期
糖尿病合併心、腎功能不全者
多發性骨髓瘤
曾對離子性對比劑過敏者
年齡大於75歲及小於3歲
多重外傷併有低血容性休克之患者。

So if the non-ionic contrast material is sufficient, then there are more cases where it’d be covered.

#17

Sorry, say what?

#18

It’s not the contrast media that makes the 3D scan different from any other CT scan. I can’t read the links you posted, but the bulk of CT scans use contrast media.

#19

Not an expert. What I gathered from the NHI page is that there are two types of contrast materials you can take for a CT. One is ionic and could have more side-effects. The other is non-ionic and is less expensive and has less side effects, but the CT scans it produces is also not as detailed. The NHI covers more conditions for non-ionic conyrast material, which includes a bunch of cardiovascular conditions.

#20

The 3D scan is expensive due to the high number of slices and the reconstruction afterwards and the fact that only very fast machines can do it ( they have to image the whole heart in between beats to prevent movement unsharpness ).

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#21

Google translation of what a friend’s cardio colleague said about my case:

The 60-70% statement is rather vague. It should be treadmil. We usually look at ST downgrading, and morphology. ST depression like upslope is not necessarily meaningful.

I don’t know if the recommendation over there is for catheterization, because I haven’t seen the film and I can’t tell whether or not to do catheterization. If the recommendation over there is for catheterization and there are symptoms, I think it can be done because it’s just a test. If the risk is not high, you can rest assured, if you have any doubts, you can do thallium scan double check

It can also be used as ct. If the result is normal, don’t worry, the disadvantage is that the false positive is high and you have to pay yourself. The benefit of Thllaium is health insurance. I usually do both tradmil and thallium if I have doubts. If there is no economic consideration, of course CT can be used.

#22

A bit cryptic.

#23

It really sounds like you should collect your medical records and go get a second opinion from another qualified professional. The cost of doing so should be next to nothing.

I’m not an expert, but I’d suggest the guy I mentioned in this post. There also seem to be other posts on here if you search for “cardiologist” or “cardiology” or whatever.