Description
Lipid is another word for fat. Lipids are easily stored in the body and serve as a source of energy. Cholesterol and triglycerides are lipids. When the concentration of triglycerides or cholesterol in your blood is too high, it is called hyperlipidaemia. Having a lipid level that is too high increases your risk of heart attacks and strokes.
Patches of atheroma are like small fatty lumps that develop within the inside lining of blood vessels (arteries). Atheroma is also known as atherosclerosis and hardening of the arteries. Patches of atheroma are often called plaques of atheroma.
What is cholesterol?
- Low-density lipoproteins carrying cholesterol are called LDL cholesterol. This is often referred to as bad cholesterol, as it is the one mainly involved in forming atheroma. Atheroma is the main underlying cause of various cardiovascular diseases.
- High-density lipoproteins carrying cholesterol are called HDL cholesterol. This is often referred to as good cholesterol, as it may actually prevent atheroma formation.
What are triglycerides?
Triglycerides are the end product of digesting and breaking down the bulky fats that are present in our food. Any food we eat that isn't used for energy immediately - carbohydrates, fat or protein - is also converted into triglycerides. Triglycerides are the main form of fat stored in the body. When you think of fat on your hips or stomach, you're thinking of triglycerides.
The signs and symptoms of hyperlipidaemia
There are usually no symptoms of hyperlipidaemia in the early years. Uncommonly, hyperlipidaemia can manifest with yellowish nodules of fat in the skin beneath eyes, elbows and knees, and in tendons; sometimes a large spleen and liver occur, or whitish rings around the eye's iris occur. Longstanding elevated cholesterol is typically associated with cardiovascular disease and therefore can lead to heart attack, stroke and/or peripheral vascular disease.
Possible causes of hyperlipidaemia
The causes of hyperlipidaemia are either genetic (familial or primary hyperlipidaemia) or from a poor diet and other specific factors (secondary hyperlipidaemia). In familial hyperlipidaemia, the high cholesterol has nothing to do with poor habits but is caused by a genetic disorder.
Other causes of hyperlipidaemia may include excessive drinking of alcohol, obesity, side effects of medications such as hormones or steroids, diabetes, kidney disease, underactive thyroid gland and pregnancy.
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.