Description
Multiple sclerosis (MS) is one of the world’s most common neurological diseases. Nerve cells in the brain and spinal cord are surrounded by a layer of protein called myelin. This layer protects the nerve and helps electrical signals from the brain to travel to the rest of the body. In MS, the myelin becomes damaged and the nerve signals are disrupted.
What are the types of multiple sclerosis?
Remitting relapsing multiple sclerosis (RRMS) is the most common of the four types of MS and is characterised by unpredictable relapses followed by months to years of relative quiet (remission) with no new signs of disease activity.
Secondary progressive multiple sclerosis (SPMS) describes a form of MS where a patient begins a progressive neurological decline between acute attacks with very few periods of remission.
Primary progressive multiple sclerosis (PPMS) describes a type of MS where symptoms steadily progress following the initial attack and disability develops at a relatively early stage. PPMS is characterised by the progression of disability from the onset, with no, or only occasional and minor, remissions and improvements.
Clinically isolated syndrome (CIS) describes an instance where patients suffer one attack.
The signs and symptoms of multiple sclerosis
Not everyone with MS shows all the signs and symptoms of the disease and no two people with the same symptoms experience them to the same degree. If you have MS, you can suffer from any of the neurological signs and symptoms, including:
- Reduced sense of touch
- Tingling or numbness of the skin
- Muscle weakness and problems with balancing
- Swallowing and speech problems
- Depression and anxiety
- Vision problems
- Extreme tiredness
- Bladder and bowel problems
- Problems with thinking, planning and learning
Symptoms of MS usually appear in episodic, sharp and severe periods of worsening known as relapses, with a progressive degeneration of the neurological function. Some symptoms can be preceded by common triggers, for example infections such as the common cold and influenza can increase the chances of a relapse, but for the most part, relapses are unpredictable, with no obvious trigger.
Possible causes of multiple sclerosis
The cause of MS is still unknown, but there are theories that the disease is caused by a combination of environmental, genetic and, as yet, undetermined factors.
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 benefit consultant will liaise with your doctor regarding your treatment. Once the diagnostic criteria have been met and x-rays (if applicable) and relevant blood results have been submitted, the treatment will be approved.
We will let you know whether the treatment falls within the Momentum Medical Scheme Reference Price. If the cost is greater than the Momentum Medical Scheme Reference Price, you will need to pay the difference.
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, a co-payment may apply.
The authorisation of your prescription is valid for 6 months. Your treating doctor will review your chronic condition 6-monthly and update your prescription when required.
- If there are no changes to the medication and/or diagnosis, the prescription can be sent directly to your DSP pharmacy.
- If there is a change to your medication prescription and/or diagnosis, then your doctor or pharmacist can contact us on 0860 11 78 59 to review the changes and renew the 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
Term | Description |
| 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. |
| 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 | Prescribed Minimum Benefits (PMBs) are conditions all South African medical schemes must cover by law. They include emergencies, 271 diagnoses and 26 chronic conditions. PMBs are fully covered if you use the Scheme’s Designated Service Providers (DSPs). If you choose a non-DSP, the Scheme pays up to its rate and co-payments may apply, unless it’s a life-threatening emergency, in which case co-payments are waived. |