Friday, August 27, 2010

Hyaluronic Acid Injection

Yesterday, my mum officially had her knee problem treated. Alhamdulillah. Its a new experience for me. I could see & experience myself as a patient waiting to be treated by a doctor. Wish in future I will look after my patient as best as possible & still concern about their social history. What do I mean about this is that a doctor must ensure the money value that been paid by the patient for the treatment & how a doctor should know how to deal with insurans company. ING, Prudential is known to cover all the cost of treatment without questions. But the problem comes when the patient use ETIQA. The patient still need to pay 10% out of all the cost (this is not a problem) but the problem arise when actually there are certain treatment that this company does not cover for example hyaluronic acid injection which cost rm1800 per injection.

Here the story goes...

The night when we had the appointment, the doctor said the injection did cover by insurans company, but the patient need to be warded first in order to cover by his or her insurans. The plan was to give 2 injections to my mother; 1 at each side. This is because she actually had OA at both knees. So, in total need to pay around 4K+ (2injections+doctor+etc)

The next morning at 10am we reached Putra Medical Centre. We waited for them to contact my mum's insurans company to get GL & sent her to ward. Before coming to hospital, my mother did call her insurans agent & ask wether this injection is covered or not. The answer given was yes & only need to pay 10% out of the bill. Ok~

At 10.30am, my mum was brought upstairs by wheel chair (its a protocol, patient need to be sent upstairs by this. Haha). My mum asked to be warded in standard room. I mean not single room. Because we were not plan to stay overnight & the procedure was just for 10-15 minutes. We were given room of 4. It was a nice room. We had our own TV. I brought along my laptop, maxis broadband & O&G book while waiting for my mother. We chose bed closest to the toilet near the window.

After about 10minutes rest, a staff came in. She actually came to clarify to us that this injection was not covered by my mum's insurans. Its happen before last week & they had big headache to settle the bill. My mum was in shock but she still calm down. I could feel by her expressions. Her worries proved by her raised in BP even up to 160/110 each time the nurses took her BP. She said she was not informed of that & this morning the agent said it was covered. So my mum called the insurans company free toll line & indeed it was not covered & the agent might not know of this because they are just agents. Duhhh~ If you work with the company, you should know all about your company's policy.

So the dilema was to proceed or not.

My mum called the agent & told her she gave her wrong informations. The agent was surprised too & appologized. Later she did came to the hospital & visit my mother. 0-0 then. Since my mother was in pain, she said she agree to pay for the injection (initially we thought only 1injection & only pay rm2k) & other the rest definitely will be cover by her insurans. But she request to see the doctor before the procedure.

At 3.30pm the doctor came & clarify everything. He said this injection was covered by other insurans without knowing actually my mums insurans did not. This one particular company always gave him problems & advice my mum to change to other company. Haha. Serves this company right.

He did called the company & talked to them how important the injection was to the patient. But they still refused to pay. The company pay for other modes of OA treatment such as arthroscopic debridement & big surgery but not this injection which only cost rm2k. The doctor did tell them based on research the efficacy of this injection & arthroscopic debridement are the same & why must the patient undergo more invasive treatment. But they still refuse. Even the doctor panel overthere refused to talked to our doctor.

Since his plan was to give 2 injections; 1 injection per knee, the solution was my mum only need to pay for only 1injection. In the bill sent to the insurans company, he will split the cost of other injection in ward & OT as if my mother warded for 3-4 days & the procedure did in OT. The doctor tried his best to give the best for the patient's need & make my mum happy. So we agreed with his explanation. The doctor then invite me to see the procedure in the procedure room & i was very happy =)

Around 4pm, we went to the procedure room. The doctor handed me over the injection box. It was Synvac one - 6ml injection. Content per ml was hylan 8mg, sodium chloride 8.5mg, disodium hydrogen phosphate 0.16mg, sodium dihydrogen phosphate hydrate 0.04mg, water for injections. Injection maybe repeated 6months after the first injection, if justified by the patient's symptoms.

After my mum's knees were swab by alcohol, a staff came in & said the GL was rejected. So the doctor stop. We discussed with the doctor & came up with this. If the company reject the bill, my mum will pay for both injections (rm4k+) as my mum want this pain to go away badly & the hospital will not charged my mum for the ward. Later, the doctor talked to the company again &they will try to push for GL from the company.

The procedure went smoothly. My mum sat at the end of the bed with both of his feet dangled at the side of bed. The doctor locate the medial joint line & flex and extend my mum's knee to confirm the site. The site for injection was the same site for arthroscopic. He did not give local to my mother as he said its not needed. My mum sometimes did grimaced. She said its only mild pain. The procedure went smoothly for both sides. I did assist him in opening 10ml cc syringe & hand over povidone.

Afterwards the doctor asked my mum to try to walk & explained how she felt. My mum kinda afraid to walk (haha) & said it did felt different but my mum couldnt explain it well. Doctor advice for us to buy brace as extra support for my mum's knee. next week, the agent for the brace will come to the house & lend my mum the brace for about a week until her next appointment which is 7th september. We thanked the doctor for his helped & we was sent back to the ward.

My mum was discharged with 2 painkillers ( I wonder why 2. hermm~) ; celebrex & ibuprofen. Later abah fetched us & went home happily. Abah giggled seeing mum being pushed in a wheel chair & abah asked mum to run in order to test the treatment. Haha~ My mum currently could walk pain free & motivated to take good care of her knee. At home she really comply with the supplements & other non-supportive measurements such as control weight, avoid high heels & avoid overusage of the knee.Yesterday indeed was an unforgetable moment for us.

As a daughter, I felt very happy I could help my mother. If we didnt help our parents, who else you expect to help them?? Again, thanx to putra medical centre, Mr Sivalingam & his staffs for their concern & hospitality =)

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