Coverage List: What’s Not Covered In Neurosurgery & Neurology Under RGHS

The Rajasthan Government Health Scheme provides a comprehensive health insurance package for government employees of Rajasthan. However, health insurance doesn’t cover every medical expense imaginable, even when it comes from the government. There is a lot of information about the coverage details for various conditions and treatments under RGHS, but do you wonder what’s not covered by the scheme? Sure, there are the basics, such as cosmetic surgery, which is not generally covered by any health insurance. But what else? Let’s find out.

Non-Medical Expenses Not Covered In Neurosurgery & Neurology Under RGHS Scheme

Neurosurgery and neurology often require serious treatment and surgical procedures to treat the patient. The medical expenses of these treatments are well-covered under the RGHS scheme. However, there are certain types of non-medical expenses that are not covered under the RGHS scheme. Here are the details.

Toiletries, Personal Comfort, Convenience, & Cosmetic Items

This is one of the sets of products that are not covered under the RGHS scheme. This means if you need to use these products during your treatment or recovery process at the hospital, the scheme will not cover the cost of these items, and you will need to pay for them. Some of the items under this set are mentioned below. You can find the complete set from this link.

• Bottles

• Brush

• Baby Food

• Powder

• Shoe Cover

• Beauty Services

• Comb

• Eau de Cologne

• Barber Charges

• Cold/Hot Packs

• Caps

• Foot cover

• Gown

• Laundry Charges

• Sanitary Napkins

• Toothpaste

• Toothbrush

There are a few items that are generally non-payable except for specific cases under this set. They are mentioned below.

• Belts or Braces - These items are payable in cases where the patient has gone through thoracic or lumbar spinal surgery.

• Leggings - This item is payable in cases where the patient has had varicose vein surgery or bariatric surgery.

• Slings - The cost of this item is borne by the scheme in cases where the patient has had an upper arm fracture. However, the coverage is only limited to one sling.

• CD Charges: The CD charges of any procedure are not payable unless the CD is explicitly requested by the insurer or TPA; in such cases, the charges are covered under the scheme.

Specifically Excluded Items Under The Policies Of RGHS Scheme

There are certain treatments and items that are specifically not covered under the RGHS due to its policies. However, these items are currently considered non-payable. If the policies of the scheme are changed in the future, they can be updated and changed to be covered under the scheme. Some of these treatments and items are mentioned below. You can find the complete list here.

Specific Exclusions Of the RGHS Scheme

• Cost of Hearing aids

• Cost of Contact lenses or spectacles

Next, let’s review treatments and items that are currently not covered as per RGHS policies.

• Hormonal treatments

• Weight loss supplies or treatment

• Infertility treatment

• Psychiatric treatment

• Obesity treatment

• Hospitalization charges for diagnosis

• Hospital admission fees

There are also specific treatment options that are not payable due to certain terms and conditions of the RGHS scheme.

• HIV/AIDS Treatment: Any treatment for HIV or AIDS is not covered under the RGHS scheme. Even if HIV is discovered accidentally in the patient’s body, the scheme still doesn’t cover the treatment costs.

• Diagnostic cost of any disease other than for which the patient is admitted to the hospital

Items Excluded Because They Are Part Of Hospital Charges

These items are not to be billed separately. They are billed inclusively among hospital charges. Some of the specific items are mentioned below. However, you can check out the complete list here.

• Surgical blades

• X-ray film

• Eye kit and drape

• Boyle’s Apparatus charges

• Band-aids

• Cotton

• Apron

• Tourniquet

• Urine Container

Conclusion

So, that is a complete overview of all the various non-medical charges that are not covered under the RGHS scheme when you go through neurosurgery. Make sure you keep these specific details in mind when you are filling out your hospitalization details on the RGHS portal, as it will ensure your claim gets accepted and settled quicker. And if you are looking for an RGHS-compliant/partner hospital that will help you go through your treatment with the least imaginable hassle, make sure you visit MediPulse hospital. You will find the best neurological treatment options at MediPulse. For more information about the hospital or the in-house neuro department, visit the hospital website.

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When Will You Need Surgery For Kidney Stones?

Kidney stones are hard deposits that are found in your kidneys. They are made out of calcium or uric acid. Kidney stones start out small, but they grow bigger when more and more minerals and waste products like uric acid are added to them. The size of the kidney stone defines the amount of problems it can cause. When the stones are small, they can be passed by the urinary tract without the need for treatment. When the stones become bigger, they tend to get stuck in the urinary tract and require surgical intervention to be removed. Here are some situations where surgery is required for removing a kidney stone.

• When the stone becomes too large to be passed down your urinary tract

• When the stone is lodged somewhere in the urinary tract causing immense pain

• When the stone is disrupting the flow of urine out of your kidneys

• When the stone has caused or causing multiple urinary tract infections in your body.

These are some of the situations where surgery for kidney stones becomes necessary. Now that you know about the situations where surgery is recommended and performed. Let’s talk about the different types of surgical options that are available for treating kidney stones.

Different Types of Treatment Procedures for Kidney Stones

• Ureteroscopy

Ureteroscopy is a treatment procedure for kidney stones. This process can treat stones in both kidneys and the uterus of the patient. This procedure is performed using a flexible and thin scope to find and remove the stones lodged in your urinary tract or uterus. This procedure is non-invasive, meaning there are no cuts made on your body for removing the stones. General anaesthesia is used to put the patient to sleep for the duration of this procedure.

This procedure does not require hospital admission as the patient can be home the same day. Doctors pass a scope through your bladder, then the ureter finally reaches your kidneys. The doctors use a small basket to remove the stones when they are small; if they are larger in size, the doctors pass a laser in through the scope as well to find and break the stone into smaller pieces.

The risks associated with ureteroscopy are

• Bleeding

• Narrowing of the ureter

• Infection

• Shock Wave Lithotripsy

Shock Wave Lithotripsy (SWL) is one of the most common forms of treatment for kidney stones. This procedure is best suited for removing small and medium-sized kidney stones. SWL is also a non-invasive procedure that does not require any cuts to be made on your body. Usually, the patient is put under local anaesthesia, and they can go home the same day itself.

This procedure starts with an X-ray or ultrasound of your kidneys to find the stone or stones located inside. Upon locating the stones, the doctor uses a high-powered shockwave to break the stones down into smaller pieces. The shockwaves go through your skin and break down the pieces inside. This completes the procedure, and the patient is advised to go home and consume large amounts of liquids to flush the stones out of their system through their urine.

SWL is a safe procedure; in rare cases, if the stone does not completely pass through your urine, the procedure can be safely repeated again until all the stones or parts of the stone are completely out of your system. Some of the side effects associated with SWL include

• Damage to the kidney

• Infection

• Stone blocking the flow of urine in the urinary tract

• Bleeding in and around the kidney

• Open Surgery

Open surgeries have become a rare form of treatment for kidney stones nowadays. However, if all the other procedures fail because the stone is too big or due to other reasons, open surgery is usually the only way to treat the problem. As the name suggests, an open surgery is an invasive surgical procedure that requires hospital admission for a few days of hospital stay to keep the patient in observation.

The open surgery process starts with the doctors using anaesthesia to knock out the patient for the period of the surgery. Then the doctors cut open the patient from the side and then cut into their kidney as well. The doctors then remove the stone from the opening created in the kidney. It can take up to 4-6 weeks to fully recover from open surgery. However, surgery does not come with its own set of side effects.

Kidney stones require medical treatment, and they need to be taken out of your system most times with surgery. It is crucial for you to understand your situation and make an informed decision along with your doctor to eliminate the stones from your system safely. Now that you know in detail about the situations where you need surgery for your kidney and the types of surgical procedures that are available to you. Be sure to pick the option that is the most affordable and best suited for your problems.

Kidney Failure And Need Of Dialysis

The filters of our body, as we know them, are two bean-shaped organs and their primary function is to remove waste and fluid from our body. They also help in maintaining the blood pressure levels of the body and keep the body functions running. Also, kidneys produce hormones that aid further in the production of red blood cells.

Healthy functioning of kidneys is absolutely necessary to keep the blood clean from toxic wastes. It is important to understand that kidney diseases or kidney failure can prove to be fatal. Kidney failure usually leads to the following ailments in the body:

●       Insufficient or disrupted blood supply to the kidneys

●       Reactions to toxic substances or any kind of auto-immune attack on the kidneys

●       Obstruction during urine flow.

Some prominent symptoms of kidney failure include prolonged nausea, fatigue, tiredness and swelling on parts of the body.

When do you need dialysis?

Kidney failure is an alarming stage where only two procedures can cure the ailment: kidney transplantation or dialysis. As and when there are signs and symptoms of kidney failure, one should immediately start with dialysis. In many cases, kidney failure does not show any evident signs and symptoms but your lab results and GFR report show poor kidney function. In such cases, the doctor may start your dialysis to reduce the complications and chances of complete kidney failure.

How does dialysis help?

The procedure of dialysis is required when more than 90 percent of the kidney cannot function properly. The need for dialysis is also measured by the GFR (Glomerular Filtration Rate), which measures the stage of kidney disease and how soon the dialysis needs to start. GFR tells your doctor about the current situation of your kidney functions and will accordingly plan your dialysis schedule.

Dialysis is a procedural way of filtering and purifying the blood and removing toxic waste from the body, using a machine. Basically, the dialysis machine replicates the function of kidneys to keep the body functions running.  Dialysis removes extra salt and other toxic wastes from the body thereby preventing its accumulation. It also helps in maintaining a certain level of important chemicals in the body such as potassium, sodium and bicarbonates.

Dialysis is of following two types and your doctor shall decide which one shall suit your body. This majorly depends upon the age and other comorbidities that you are suffering from.

1.     Hemodialysis: In this procedure, the blood of your body is filtered outside the body and then again put back in the body. In order to conduct this procedure, a minor surgery is done on your leg or arm, to make an entrance to the blood vessels. The blood is then passed through a hemodialyzer to remove the toxic waste.

2.     Peritoneal dialysis: In this procedure, the blood is cleaned and filtered inside the body with the help of a fluid that is injected into the body. The fluid is injected into the abdomen and it absorbs all the waste from the blood that passes through the abdominal cavity.

Can kidney failure be permanently cured?

Kidney failure is a kind of severe damage to your organs and may require prolonged treatment and dialysis, for the kidneys to function better. If the kidney failure is acute, the kidneys can get better after treatment or after certain sessions of dialysis. In cases of chronic kidney failure, the patient may have to depend on dialysis for the rest of their lives, since the kidneys are permanently disabled to function properly. In such cases, the only cure is kidney transplant.

Usually after starting dialysis, it may become a permanent part of your life. But you should always take care of your body with proper nutrition and a healthy diet to benefit from dialysis and to maintain healthy functioning of kidneys.

Life Before And After Dialysis Begins

The human kidneys are two bean-shaped organs that are located in the belly region, right under the rib cage and diaphragm. Located one on each side of the spine, the kidneys' primary function is to remove the waste and extra fluid that the body accumulates during the day to day functioning. Apart from this, the kidneys also maintain healthy blood pressure, keep the bones strong, maintain proper mineral levels, and produce the hormone that promotes the formation of red blood cells. But what happens when the Kidney loses its ability to function due to an illness or injury?

An extreme condition in this scenario is referred to as Kidney failure and is potentially dangerous for the body. Marked by symptoms like nausea, vomiting, swelling, or fatigue, acute kidney failure can hamper daily body functions. This is where Kidney dialysis comes into the picture, wherein it performs the functions that kidneys can no longer perform.

What is Dialysis?

Dialysis is a form of treatment that takes over the normal functioning of the Kidney when the organ ceases or depletes in its working. There are usually 2 ways that Dialysis can be performed.

●       Hemodialysis: When the blood is filtered outside the body using a Dialysis Machine and is then returned to the body. The process can be done at a facility or at home.

●       Peritoneal Dialysis: The blood is cleaned inside the body by introducing a special fluid in the abdominal cavity. After cleaning the blood, the fluid is drained out.

What Should a Patient Know Before Dialysis?

Dialysis is a life changer for patients as the frequency of cleaning the blood through hemodialysis is '5 to 7 times a week'. For better understanding, patients can realize that while an active kidney works the whole day, a dialysis machine cannot be connected to a person the entire while to purify. That is why such a frequency of dialysis is required to keep the body healthy and in working condition.

A patient can always make the decision of whether he/she wants to make visits to the center for dialysis or wants to get it done at home. Not only does it require dietary changes, but it also demands conscious changes in our day to day functioning. It is also advised to the patients to get medical insurance before the beginning of Dialysis and to remember to maintain a work-life afterward as it is important for recovery.

After Dialysis Begins

Dialysis, as a procedure, is not a one-time, one-off short treatment option for people suffering from Kidney Failure. In one sitting, dialysis can range from about a couple of hours (at home, daily) to about 5 hours (in clinics, 5 times a week).

Before the beginning of Dialysis, the doctors surgically implant a device to easily reach our bloodstream. This is either done by creating a fistula (Joint Artery and Vein in Arm), a graft (Joint artery and vein with a tube), or a catheter (a thin tube in the vein of the neck). For performing dialysis, these sites receive two tubes to allow the blood to pass through the dialysis machine and back into the body. The patient is asked to wear comfortable clothing and is advised to fast for a considerable amount of time before the treatment.

It is generally a painless procedure. However, patients are always advised to talk to a doctor immediately if there is any pain during the treatment. There will be side effects of the treatment like nausea, vomiting, dry or itchy skin, muscle cramps, and fatigue, but these can be kept in check by making small adjustments to diet and water intake for the patient, with proper emphasis on salt and protein. A piece of great advice to Dialysis patients is to stop the use of alcohol, smoking, and drugs that can harm their kidneys further. The patient is also advised to limit their intake of potassium, phosphorus, sodium, and any form of liquid.

Kidney Dialysis is not the end of life, in fact, it is the road towards a better life. Therefore, we must make sure we are taking care of ourselves in all aspects to maintain quality of life. Keeping the spirits high and indulging in work is the best way to ensure normalcy.

Understanding your medical needs, we, at Medipulse, are equipped to provide you quality treatment and care, keeping all your worries at bay. Ranked as the best private hospital in Jodhpur, our Nephrology department is housed with the latest technology and equipment to provide a range of treatments from Dialysis to Transplant, etc. Our Nephrology Department is led under the expert guidance of Dr. Mayank Jain. Visit the department for consultancy and other information.