Description
Chronic renal failure is a condition where there is gradual loss of kidney function, this then decreases the ability for the kidney to work properly. By the kidney not working at its optimum level, it causes a build-up of waste products/toxins in your blood stream, which makes you unwell.
Most people may not have any severe symptoms until their kidney disease is severe. However, you may notice that you have one or more of the following symptoms:
- feeling tired and drained of energy
- trouble concentrating
- poor appetite
- trouble sleeping
- muscle cramping at night
- swollen feet and ankles
- puffiness around your eyes, especially in the morning
- dry and itchy skin
- the need to urinate more often, especially at night
Stages of kidney failure
| STAGE | eGFR (Estimated Glomerular filtration rate) | Description |
| Stage 1 | >90 | Signs of mild kidney disease but with normal or better GFR (greater than 90% kidney function) |
| Stage 2 | 60-89 | Signs of mild kidney disease with reduced GFR (indicating 60% to 89% kidney function). |
| Stage 3 | 30-59 | Signs of moderate chronic renal insufficiency (where the GFR indicates 40% to 59% kidney function) |
| Stage 4 | 15-29 | Signs of severe chronic renal insufficiency (where the GFR indicates 15% to 29% kidney function). |
| Stage 5 | <15 | Signs of end stage renal failure (where the GFR indicates less than 15% kidney function). |
Once diagnosed, your doctor will discuss your treatment plan depending on your overall profile and the stage of your kidney disease. Your treatment options may include one or more of the following:
- Blood pressure medication
- Cholesterol lowering statins
- Anaemia management
- Calcium and Vitamin D supplementation
- Low protein diet
- Dialysis
- Kidney transplantation
Momentum Medical Scheme’s chronic renal disease programme
The programme gives members who have a risk of renal failure, or who are currently in renal failure or transplant benefit, access to specialised care. This includes education, lifestyle support, medication, diet, haemodialysis, peritoneal dialysis or kidney transplantation.
Who needs to register and how?
You need to register if you have been diagnosed by your treating doctor, and you meet the diagnostic criteria for chronic renal disease.
- Ask your treating doctor to complete the chronic renal application form and email it to [email protected], together with
- pathology reports,
- urea and electrolytes,
- full blood count and iron profile, and
- chronic script with ICD-10 codes.
The chronic script should be emailed to [email protected].
- If the criteria are met, the chronic condition will be registered. Chronic renal failure has a list of medications (known as a formulary) that can be used to treat the condition. If approved, your treating doctor will be informed whether the drug is on the list, and if you will need to pay a co-payment.
- Momentum Medical Scheme also provides a treatment plan, covering all the necessary doctor and allied professions visits (such as renal dialysis technicians or dieticians), as well as investigations necessary to manage your condition. Other benefits may be allocated where necessary.
- You need to take the prescription to your pharmacist, whereafter claims can be submitted for the approved condition. If you have chosen Associated as your chronic provider, you need to get your chronic prescription from an Associated GP and your chronic medication from Medipost. If you get your chronic medication from a pharmacy other than Medipost, Momentum Medical Scheme will only pay 50% of the formulary price.
- If you need to be hospitalised for your condition, 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. A case manager will help coordinate your hospital stay.
- If you are on the Ingwe or Evolve Options, you are covered for Prescribed Minimum Benefits at State facilities. If you are on the Custom, Incentive or Extender Options, and have chosen State as your chronic provider, you need to make use of State facilities for renal dialysis. If chronic dialysis/ treatment is not available or cannot be accessed at a State facility, a letter on the State facility’s letterhead and a letter of motivation from the nephrologist, must be emailed to [email protected] to review the request. Where this is not available, you will be advised of the outcome, as well as the authorised renal provider. This information will be provided to you at pre-authorisation stage.
- A dedicated Dialysis and Transplant Programme Coach works closely with you and specialised clinical staff to ensure that you receive high quality and effective care if you have been diagnosed with end-stage renal disease and need dialysis or transplantation.
- Dialysis is ongoing and your treating doctor can contact our call centre annually for an authorisation number.
- For any changes of treatment type, we need a written motivation from your treating doctor. This can be emailed to [email protected].
Benefits of the chronic renal disease programme
- Your chronic renal disease medicine is paid from the Major Medical Benefit, subject to our formularies (a formulary is a list of medicines covered on your option from which a doctor can prescribe the appropriate medication for your condition).
- Investigations and consultations are paid from the Major Medical Benefit:
- Each registered chronic renal failure or dialysis patient gets a yearly treatment plan, with all the procedures, investigations and consultations you need.
- Member engagement and communication:
- We will contact you via telephone and encourage you to follow clinical care according to your health needs, in collaboration with your treating doctor.
- Provider profiling and communication:
- We find the most appropriate general practitioners and specialists to make sure you receive the best quality and most affordable care.
- Easier access to benefits to manage any complications of chronic renal disease. The Scheme’s designated service providers for renal therapy are
- B Braun
- National Renal Care
- Life Healthcare
For more on your chronic benefits and where to obtain chronic medicine and treatment, click here.
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. |
| Formulary | A a list of medicines covered on your option, from which a doctor can prescribe the appropriate medication for your chronic condition. |
| ICD-10 | The diagnosis code. |
| Prescribed Minimum Benefits | A 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. |