Description
Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhoea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people. The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue. Crohn's disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.
The signs and symptoms of Crohn's disease
- Diarrhoea is a common problem for people with Crohn's disease. Intensified intestinal cramping can also contribute to loose stools.
- Fever and fatigue - many people with Crohn's disease experience a low-grade fever, likely due to inflammation or infection. You may also feel tired or have low energy.
- Abdominal pain and cramping - inflammation and ulceration can affect the normal movement of contents through your digestive tract and may lead to pain and cramping. You may experience anything from slight discomfort to severe pain, including nausea and vomiting.
- Blood in your stool - you might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult blood).
- Mouth sores - you may have ulcers in your mouth similar to canker sores.
- Reduced appetite and weight loss - abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.
- Perianal disease - you might have pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula).
- Inflammation of the skin, eyes and joints; inflammation of the liver or bile ducts and/or delayed growth or sexual development in children may exist in people with severe Crohn’s disease.
Possible causes of Crohn's disease
The exact cause of Crohn's disease is unknown. It is a condition that occurs when your body's immune system mistakenly attacks and destroys healthy body tissue (autoimmune disorder).
- Immune system - it is possible that a virus or bacterium may trigger Crohn's disease. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract too.
- Heredity - Crohn's is more common in people who have family members with the disease, so genes may play a role in making people more susceptible. However, most people with Crohn's disease don't have a family history of the disease.
When to see a doctor
- Abdominal pain
- Blood in stool
- Ongoing bouts of diarrhoea that do not respond to over-the-counter medication
- Unexplained fever lasting more than a day or two
- Unexplained weight loss
How to register on the chronic programme
Once you have been diagnosed, please ask your doctor to contact our Chronic Medicine Department on 0860 11 78 59 to register you on the Chronic Medicine Management Programme.
The chronic medicine consultant will liaise with your doctor regarding your treatment. Once the diagnostic criteria have been met and x-rays (if applicable) and blood results have been submitted, the treatment will be approved. We will let you know whether the treatment falls within the Momentum Medical Scheme formulary or if you will need to pay a co-payment.
Once you receive authorisation, you can take your prescription to your designated service provider to get your medication and the claim can be submitted. A designated service provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is a medical scheme’s first choice when its members require diagnosis, treatment or care for a Prescribed Minimum Benefit condition. If you voluntarily choose not to use the DSP and choose to rather use a different hospital, doctor or pharmacy, we may charge a co-payment.
The authorisation usually expires after 12 months. If there is no change in the medicine you need to take, your doctor or pharmacist can contact us on 0860 11 78 59 to renew the authorisation. The same process applies when there are any changes or additions to your authorisation.
For more on your chronic benefits and where to obtain chronic medicine and treatment, click here.
Hospitalisation
If you need to be hospitalised for complications related to your illness, log in to the Momentum App, contact us via the web chat facility on momentummedicalscheme.co.za, email us at [email protected], send us a WhatsApp message or call us on 0860 11 78 59 to request pre-authorisation. We will allocate a case manager to follow up regarding your hospital stay.
Treatment plan
Once you are registered on the programme, you will have access to a treatment plan, which may include cover for tests, doctors’ visits or other benefits considered medically necessary by your doctor – these will be reviewed by our clinical team to ensure appropriateness.
Compliance
You need to:
- obtain your chronic medication on a monthly basis,
- make sure that you take your medication according to the dosage and quantity prescribed by your doctor, and
- make sure that you do not miss a dose - this is not only important for compliance, but it can have serious implications for your health and wellbeing.
Please make sure your claims have the appropriate ICD-10 code
It is important for all claims to include the appropriate ICD-10 codes (diagnostic codes), so we can identify the claim correctly and pay it from the Chronic Benefit.
We may pay claims from your Day-to-day Benefit if:
- The claims are submitted without the relevant ICD-10 codes.
- You have exceeded the frequency limit on consultations or tests.
- The treatment is not clinically appropriate.
Contact us
You can contact us via the web chat facility on momentummedicalscheme.co.za, email us at [email protected], send us a WhatsApp message or call us on 0860 11 78 59.
Glossary of terms
Designated service providers: Momentum Medical Scheme uses a network of designated service providers, such as Associated GPs and Specialists, as well as State facilities, depending on the circumstances, to diagnose and treat our members for the Prescribed Minimum Benefits.
A formulary is a list of medicines covered on your option, from which a doctor can prescribe the appropriate medication for your chronic condition.
ICD-10 is the diagnosis code.
Prescribed Minimum Benefits is a list of benefits for which all medical schemes in South Africa have to provide cover in terms of the Medical Schemes Act No 131 of 1998. The Prescribed Minimum Benefits include life-threatening emergency medical conditions, a defined set of 271 diagnoses and 26 chronic conditions. Benefits are covered in full if you use the Scheme’s Designated Service Providers (DSPs). If you voluntarily choose to use non-designated service providers, the Scheme will pay benefits up to the Momentum Medical Scheme Rate and relevant co-payments will apply. If you use non-designated service providers in a life-threatening emergency, it is deemed involuntary and co-payments are therefore waived.