Health insurance for joint fluid replacement injections

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Are joint fluid replacement injections covered by health insurance?

The cost of joint fluid replacement injections is covered through extras health insurance, but only on a couple of policies. The benefit payment will assist in covering the costs of fluid injections to joints including the knee, hip and shoulder, such as visco-supplemental treatments.

What are joint fluid replacement injections?

Joint fluid replacement injections involve replacing damaged joint fluid from an area affected by osteoarthritis with something called hyaluronan. Hyaluronan is a natural substance found in the synovial fluid of your joints. This fluid cushions and lubricates joints and reduces friction. Brand names for this fluid you might be more familiar with include Synvisc, Durolane, and Osteoartz.

Are hyaluronic acid injections covered by Medicare?

Unfortunately, hyaluronic acid injections are not covered by Medicare. The Medicare Benefits Schedule rules out benefits for intra-articular viscosupplementation to treat osteoarthritis of the knee, and hyaluronan products such as Synvisc and Durolane are not listed on the Pharmaceutical Benefits Scheme (PBS) either. This means that they can end up being quite expensive if no cover is provided by your private health insurer.

How much do knee injections (like Synvisc) cost?

Without insurance, what you pay comes down to the fluid plus your specialist appointments. The cost of the fluid itself can be in the $450-$600 range, but you'll also need to pay for your initial and subsequent consults/injections, which can be several hundred dollars each.

What are joint fluid replacement injections used to treat?

A joint fluid replacement injection eases the pain of osteoarthritis in a range of affected joints. These affected joints most commonly include the knee, hip and shoulder joints, but injections may be given to other parts of the body in some cases.

Osteoarthritis is caused by wear and tear on joints and results when the protective cartilage that cushions the ends of bones breaks down. This cartilage can break off into small pieces and end up in the synovial fluid, causing swelling and irritation. Discomfort and pain soon follow, but joint fluid replacement injections can often help reduce these symptoms.

Although this treatment doesn’t reverse the effects of arthritis, it can alleviate pain and swelling in affected joints for several months. Not only can this greatly improve your quality of life on a day-to-day basis, but it can also help delay any need to undergo joint replacement surgery.

Joint fluid replacement injections can be used to treat osteoarthritis pain in a wide range of cases, so your doctor will advise you if this treatment is appropriate in your situation. If you require long-term management of osteoarthritis pain, your doctor may recommend that you undergo a course of injections more than once a year.

Are there any side effects?

While all medicines can potentially have side effects, some patients may experience them and others may not. Side effects associated with joint fluid replacement injections are generally quite rare but can include the following:

• Mild pain and swelling around the site of the injection, which usually goes away within a few days
• A rash or hives and itching
• Nausea
• Headaches and dizziness
• Muscle cramps and swelling
• Breathing difficulties
• Infection

Your doctor will be able to advise you about any potential side effects before beginning treatment. You should always seek medical attention if you experience any side effects after receiving a joint fluid replacement injection.

Frequently asked questions

• What type of extras cover provides benefits for joint fluid replacement injections?

  Joint fluid replacement injections are typically covered under higher-tier extras health insurance policies. While most basic and medium-level extras policies may not include this benefit, you are more likely to find coverage with comprehensive or top-level extras plans. It is always best to check the specific product disclosure statement for any policy you are considering or contact the health fund directly.

• What is the waiting period for joint fluid replacement injections on health insurance?

  Like most extras services, a waiting period typically applies before you can claim benefits for joint fluid replacement injections. This waiting period is usually two months from the date your policy commences or upgrades to include this cover. For pre-existing conditions, a longer waiting period of 12 months may apply.

• How do I claim for joint fluid replacement injections with my private health insurance?

  To claim for joint fluid replacement injections, you will typically need to submit an itemised receipt from your specialist or clinic to your private health insurer. Some funds allow you to claim on the spot via HICAPS, while others may require you to submit your claim online, through their app or by mail. Ensure your receipt includes all necessary details such as the provider number, item codes and the cost of the injection.

• How many joint fluid replacement injections can I receive in a year?

  The number of joint fluid replacement injections you can receive and claim benefits for in a year often depends on your specific health insurance policy and your annual limits. Most policies will have a financial limit for ancillary services like these, rather than a specific number of injections. Your doctor will advise on the appropriate course of treatment for your condition, which may involve multiple injections over time.

• Can I choose my specialist for joint fluid replacement injections with private health insurance?

  Yes, generally you have the freedom to choose your preferred doctor or specialist for joint fluid replacement injections. Private health insurance extras cover usually allows you to see any recognised provider for eligible services. However, it is always a good idea to confirm with your health fund if your chosen specialist is recognised for claims before undergoing treatment.

To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.

Written by

Richard Laycock

Editor

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Richard Laycock is Finder’s insights editor after spending the last five years writing and editing articles about insurance. His musings can be found across the web including on MoneyMag, Yahoo Finance and Travel Weekly. Richard studied Media at Macquarie University and The Missouri School of Journalism and has a Tier 1 Certification in General Advice for Life Insurance. See full bio