P&H HC Orders Full Reimbursement for IVL Angioplasty, Rejects Haryana's Hyper-Technical Denial of Life-Saving Cardiac Procedure
An 85-year-old retiree's Rs 7.42 lakh cardiac bill was denied because Intravascular Lithotripsy was not listed in Haryana's package schedule. The High Court found that medically necessary treatment cannot be refused on that ground.
The Punjab and Haryana High Court at Chandigarh has directed the State of Haryana to reimburse the entire medical bill of Rs 7,42,630/- incurred by an 85-year-old retired government employee who underwent Intravascular Lithotripsy (IVL) angioplasty for critical Coronary Artery Disease. Justice Harpreet Singh Brar, sitting singly, held on 5 May 2026 that the State's refusal to reimburse the procedure solely because IVL does not appear in the approved package list under the Haryana Government's medical reimbursement policy dated 14 July 2020, was a hyper-technical approach that defeated the very purpose of a welfare policy. The court went further, directing the State to consider including IVL within the package rates for coronary artery disease and to audit the billing practices of all empanelled hospitals.
The Dispute Before the Court
The petitioner, Hukam Singh, was 85 years of age when he presented at Paras Hospital, Panchkula, on 19 April 2023 with symptoms of critical Coronary Artery Disease. He was admitted the same day and discharged on 22 April 2023. During the admission, doctors found that his coronary blockages were heavily calcified, making routine balloon angioplasty and stenting ineffective. The treating team instead employed two advanced techniques: Rotablation and Intravascular Lithotripsy (IVL), which uses a specially designed balloon catheter to deliver acoustic shockwaves to break calcified coronary plaques.
The hospital charged Rs 1,05,000/- for the angiography-cum-angioplasty and Rotablation packages and Rs 6,02,469.64/- separately towards medicines and consumables, including Rs 3,50,000/- for the IVL catheter alone. The petitioner filed a legal notice on 17 November 2023 seeking reimbursement of the full bill. When no satisfactory response came, he filed CWP-28175-2023 under Articles 226 and 227 of the Constitution, seeking a writ of mandamus directing the respondents to release Rs 7,42,630/- along with interest at 18% per annum.
Hukam Singh passed away during the pendency of the petition. On 2 December 2025, the court allowed an application under Order 22 Rules 1, 2 and 3 read with Section 151 of the Code of Civil Procedure to implead his legal heirs, who continued the proceedings.
Haryana's Position and the Package Policy
The State of Haryana, through its Additional Advocate General, maintained that all admissible benefits had been released in accordance with the policy dated 14 July 2020. The Director General of Health Services, Haryana, filed a compliance affidavit dated 15 January 2026 setting out the State's position in detail.
The policy defines “Package Rate” as a lump-sum cost inclusive of admission charges, consultation fee, preoperative investigations, operation charges, anaesthesia, surgical disposables, consumables, gas charges, medicines during hospitalisation, physiotherapy, nursing care, routine post-operative ICU stay, blood transfusion, and medicines for seven days after discharge. The State's affidavit confirmed that Paras Hospital had charged the petitioner as per Package Nos. 26/26 and 27/27 of Annexure-I for Angioplasty and Rotablation respectively.
On the IVL catheter costing Rs 3,50,000/-, the State's position was that there is no package rate for Intravascular Lithotripsy, making it a non-package procedure. Accordingly, the State argued, the IVL catheter was a consumable reimbursable only under Para 4(a)(iii) of the policy, which allows reimbursement of medicines and consumables at Rs 1,750/- per day, with an additional Rs 2,000/- per day for high-cost injections. Paras Hospital, as respondent No. 5, supported this position, submitting that IVL balloons differ from those used in standard angioplasty and that IVL is therefore not part of the angioplasty package.
The court had, on 2 December 2025, directed the State to file an affidavit explaining how package rates are fixed under the policy and to clarify whether the practice of lowering package rates while billing medicines and consumables separately was permissible. The Director General's affidavit of 15 January 2026 was filed in compliance. It acknowledged that the hospital had charged the cost of stents and the Rotablator under the head "Medicines and Consumables" instead of "Implant/Device," and that those items were reimbursable in addition to the package rate. On IVL, however, the State maintained its position that it fell within the consumables cap.
How the Bench Reasoned
Justice Brar found the factual position undisputed: the petitioner needed IVL because conventional angioplasty would have been ineffective for his heavily calcified coronary blocks. The genuineness of the medical bills was not in dispute. The only basis for denial was that IVL does not appear in the approved package list and that the IVL catheter is a consumable under Para 4(a)(iii).
The court rejected the State's characterisation of IVL as unrelated to angioplasty. Referring to a published article in the Journal of Vascular Surgery Cases, Innovations and Techniques (PMCID: PMC10011829), the court noted that the procedure is described as “intravascular lithotripsy angioplasty” and that the Shockwave IVL device uses an angioplasty balloon to deliver acoustic shockwaves to the arterial wall. On this basis, the court held that IVL is a specialised modality of angioplasty designed for heavily calcified vascular lesions where ordinary balloon angioplasty may not be sufficient. The State's stand that the two procedures are distinct and unrelated was, in the court's view, fundamentally misconceived.
The court was equally critical of the attempt to classify the Rs 3,50,000/- IVL catheter as a routine consumable under Para 4(a)(iii). That provision, the court observed, was evidently intended for routine items such as syringes, gauze, dressings, or oral medications, not for a specialised shockwave-delivering angioplasty catheter that is the very essence of the IVL procedure. To reduce such a device to a routine consumable was, in the court's words, irrational, illogical, and a gross misclassification.
Justice Brar drew a pointed contrast: the State accepted that IVL was the only viable course of treatment, yet denied the claim because the procedure was not on a list. The court observed that the respondents had chosen to adhere to the policy in its letter while turning a blind eye to its spirit. It held that a policy meant to preserve life cannot become a rigid instrument of denial on hyper-technical grounds. The test, the court said, cannot be what is listed; the test must be what is medically necessary to save a life.
The court also made a pointed observation about what the State's logic implied: had the petitioner undergone conventional angioplasty, even though it would have been ineffective for his calcified blockages, the State would have reimbursed it simply because it appears in the package list, regardless of whether it saved his life. The court said it could not accept such a hollow approach.
The court placed the issue within the constitutional framework of a welfare state, holding that medical reimbursement policies are fiscal instruments of social security designed to protect beneficiaries in times of medical distress. To accept treatment as medically necessary yet deny its cost on a technical ground was, in the court's view, tantamount to defeating the spirit of the policy and rendering the fundamental right to health a hollow promise. The court relied on the Supreme Court's judgment in Surjit Singh v. State of Punjab, 1996 INSC 157, and the Punjab and Haryana High Court's own decision in Kapoor Singh v. State of Punjab and Others, CWP-39210-2025.
On the broader billing concern, the court found prima facie that empanelled hospitals had been artificially lowering package rates to attract patients and then billing medicines and consumables separately. The Director General's affidavit confirmed that the hospital had placed the cost of stents and the Rotablator under "Medicines and Consumables" rather than "Implant/Device." The court directed that this practice shall not be permitted.
Outcome
Justice Brar disposed of CWP-28175-2023 on 5 May 2026 with four directions:
The respondents are directed to reimburse the entire medical bill of the petitioner along with interest at 6% per annum from the date it became due until the date of actual realisation.
Respondent No. 2 is directed to consider inclusion of the IVL technique within the package rates for coronary artery disease, including stenting and ballooning procedures, and to amend the policy accordingly.
The Director General of Health Services, Haryana, is directed to verify the package rates of all empanelled hospitals, either personally or through the concerned authorised Civil Surgeon. Where any empanelled hospital is found to be violating the policy, appropriate corrective measures shall be taken, including cancellation of licence. The Director General is further directed to ensure that the cost of treatment is explained to the patient or their next of kin in a language they are familiar with, rather than merely obtaining signatures on cyclostyled proformas.
Respondent No. 2 is to file a compliance report before the court within three months from the date of receipt of a certified copy of the order.