Tryst with Medical Fraternity

My mother aged 72 years had a fall because a young child crossed her way while playing. She sat down on the ground and could not get up. She was brought home by some helpful people.

Upon simple visual examination we did not find any visible signs of a fracture like swelling or unbearable pain. Of course, she found it difficult to move right leg and had pain it was moved. So, a young physiotherapist was called in. She examined her and said that possibly there is no fracture and few sessions would do good to her. She started with some mild treatment on first day. But next day my mother sensed more pain compared to the previous day. So, we stopped her treatment - fearing that exercise may aggravate the pain and some experienced person should be called in.

Our friendly neighbour suggested a local bone-setter (hadd-vaidya) whose 3 generations have been curing ailments related to bones and setting bones. One young man arrived quickly and applied some oil and with a wooden massage aid and did some massage. My mother felt relief after the massage. He asked her to do Ice massage every few hours and apply a ayurvedic concoction (llap) every alternate day. He opined that hip joint ball is safe and fracture is not there. Even if it is there it could be hair line fracture. He suggested X-ray after few days of massage therapy - when things would get normal.

Next day we noticed a small red patch on the upper thigh. Next day it became bigger in size. When we inquired about it the young man said it's a good sign. He said, there is an injury inside (near bone) and blood oozing from there is now coming to the surface. It will become bigger and slowly fade in color and disperse. True to his explanation - the red patch became bigger and slowly started fading. But recovery was not good i.e., pain persisted after few massages also.

In the mean time, we contacted few clinics for a portable X-ray unit. We could locate one in our locality and contacted them. They said technician is on leave due to Diwali festival and he would return only after Diwali. We could not find any other lab with portable X-ray equipment.

So we called in the senior bone-setter. He found one leg to be shorter than other; and did some settings in his own way. He even moved the right leg up to the chest slowly; and there was not much pain. He also opined that possibly there is no fracture and she would become normal in about 10-15 days. My mother felt better after the visit. But after 2-3 days thing were back to old pain; and Diwali also came to an end.

On the first day after the Diwali, we called in the technician with portable X-ray machine. He promptly came and within half hour called saying there is a fracture in the hip joint requiring possibly an operation. My wife rushed to an Orthopaedic Surgeon and showed the report. He suggested surgical operation to fix the fractured bone with the help of a plate and screws. He mentioned his fees for operation and suggested that operation be done in some other hospital with ICU unit because of my mother's old age. He said all other charges for the hospitalisation will be extra. Upon inquiry he said cost of the Medicines, Operation theater and Anesthesiologist fees will be extra. Fine. He suggested two hospitals.

We inquired and settled with one because other one was almost full with only one vacant bed. I got contact of an Ambulance operator from the hospital. Contacted him to get Ambulance with a Wheel Chair. Rates quoted were higher than indicated by the hospital staff. So, after a negotiation we settled for Rs.550/- for a 500 meter ride to hospital!

Next day ambulance came one hour late after half a dozen phone calls. A young boy came in with a folded wheel chair. He did not know even how to open the folded wheel chair. After some struggle he managed and then put my mother in it and took it to the ambulance. The wheel-chair was lifted by 3 people to put inside the ambulance. But the wheel chair won't go inside because space between two cots was not enough to accommodate it. So, they lifted my mother and put her on one of the cots and made her sit there. Thus we reached the hospital. Ambulance guy had not brought the Bill for ambulance and demanded full money with promise to bring Bill by same day evening. After one week's follow-up we got the bill. I vowed not to call this Ambulance Service again and even gave feedback to the hospital about the service we got from them.

Experience at Hospital was good. Hospital insisted and made us sign a letter which stated that we will purchase all medicines from their own medical shop at Maximum Retail Price. Admission staff was naive and in-experienced but nursing staff was adequate in numbers and was of good quality. They were very prompt and gave required services with smile and speed. I paid the required deposit to the hospital by cheque first time on the day of the admission and second time just after the operation.

Just before the operation was to be commence Orthopaedic Surgeon inquired if we want to put 'steel' plate costing Rs.10,000/- or titanium plate costing Rs.17,000/-. This was a googly. He had not even informed us that cost of plate was not included in his fee for operation! My sister and brother-in-law, both of them doctors - who were present there - had no clue. So, we arbitrarily decided for one of them in absence of much information. We wish we had known about this earlier and could have taken an informed decision.

Operation went on well. Then after two days my mother was found fit to be discharged from the hospital. I had done some rough calculations of all expenses and made cash withdrawal from the bank with some extra amount. And we were presented with the rough bill. It turned out to be much higher than my rough calculations. So, upon getting detailed break-up of various items I learnt that they had included following items which I was unaware:

a. Doctor's visit fees for 5 visits at Rs.1,000/- each. One involved short walk with a walker, second involved dressing, other 3 just to inquire if everything was fine.

b. Handling fee charged by hospital at 10% of the cost of the plate that was fixed during the operation.

c. Cost of monitoring equipment used by the Surgeon during the operation was charged extra. We were not informed about its charge earlier.

d. Service Charges at 5% of the total hospital bill including cost of plate and consumables used during the operation.

Upon inquiry I learnt from my insurance agent that Service Charges would not be reimbursed by the insurance company unless proper description of service is given in writing. Upon inquiry I was asked to meet senior administrative staff about details of Service charge. Accounts department had only one person on duty; and she had no clue about description or rationale of service charge; but she knew that insurance company don't pay Service Charge to the patients.

After few days I called up and inquired about it with a senior person (Director - Medical). He said they charge only 5% against 10 to 12% charged by many other hospitals. He explained that it is towards nursing and other services rendered by the hospital to the patient. I requested him to give this explanation about Service charge in writing so that I can check with insurance company for reimbursement of the same. Also, I asked him if is fair to levy this charge on the Doctor's Operation and Visit fees - as I had never factored the same - while agreeing on Doctors fees. Also, I suggested to him that hospital should display notice about this at few prominent places. He promised to look in to it and get back in 2-3 days.

Any way, I paid the balance amount by Credit Card. And brought my mother back home. Now, she is recovering and will take about 1 month with walker; and two more month to get back to normal health.

Summary:
Have medical insurance cover with adequate financial limit. When there is a need to go for hospitalization for a medical treatment be sure of following charges while deciding on hospital and doctor's fees:

1. Surgeon's fee including consultation fee, operation fee, cost of post operative treatment like dressing, physio therapy etc. Ask cost of Implants (if any) for various options available.

2. Fees for Anesthesiologist. Typically it is 20% of the surgeon's operation fee.

3. If patient is aged i.e., above 60 years then Physician's medical medical fitness certificate along with various tests like Blood Sugar, X-Ray, Cardiogram etc. will be there.

4. Hospitalization fees e.g., Room Charges, Operation Theater charges, Cost of monitoring equipments, Cost of Implants with handling fee, Cost of various medical tests, Cost of medicines, Service charges on entire amount (typically 5 to 12%).

5. Cost of Ambulance including wheel chair and other equipments.

If you have medical insurance then cost of room per day is typically 1% of the insurance cover. Try to select a room around this amount. If you decide to go for a higher price room then keep in mind that most of the costs (medical tests, doctor's fees etc.) will go up proportionately. Also, if you are not careful you may end up calling dietitian advising you what to eat during and after operation; with accompanying consultation fee bill.