Description
Glaucoma is a group of diseases that damage the eye’s optic nerve. It is often associated with a build-up of pressure inside the eye. Glaucoma tends to be inherited and may not show up until later in life.
The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to the brain. If damage to the optic nerve from high eye pressure continues, glaucoma will cause permanent loss of vision. Without treatment, glaucoma can cause total permanent blindness within a few years. However, with early detection and treatment, you can often protect your eyes against serious vision loss.
Narrow-angle glaucoma
Acute narrow-angle glaucoma occurs suddenly, when the coloured portion of your eye (iris) is pushed or pulled forward. This causes blockage of the drainage angle of the eye, where the trabecular meshwork allows outflow of fluids. When internal eye structures are blocked in this way, your eye's internal pressure (intraocular pressure or IOP) may spike and possibly damage the optic nerve that transmits images from the eye to the brain.
Primary open-angle glaucoma
Chronic glaucoma, also known as primary open-angle glaucoma or POAG, is sometimes called "the silent thief of sight" because in the early stages of the disease there are no warning signs - no pain or vision loss or other hints that something is wrong. Because of this sneaky nature of the disease and the devastating vision loss it can cause as it progresses, it is essential to have routine eye exams to make sure you are not developing early primary open-angle glaucoma.
Possible causes of glaucoma
Glaucoma causes include elevated eye pressure (called intraocular pressure or IOP) due to the eye’s inability to drain fluid efficiently. Glaucoma can often be caused by another eye condition or disease. This is known as secondary glaucoma. For example, someone who has a tumour or people undergoing long-term steroid therapy may develop secondary glaucoma.
Other causes of secondary glaucoma include:
- Eye injury;
- Inflammation of the eye;
- Abnormal blood vessel formation from diabetes or retinal blood vessel blockage;
- Use of steroid-containing medications (pills, eyedrops, sprays); and
- Pigment dispersion, where tiny fragments or granules from the iris (the coloured part of the eye) can circulate in the aqueous humour (the fluid within the front portion of the eye) and block the trabecular meshwork, the tiny drain for the eye’s aqueous humour.
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.