Focus on the chronic renal disease programme

Chronic renal failure is a medical condition characterized by the progressive deterioration of kidney function over time. This gradual decline in kidney performance significantly impairs the organ's ability to filter waste products and toxins from the bloodstream effectively. As kidney function decreases, harmful substances accumulate in the blood, leading to a variety of health issues and making individuals feel unwell. It is important to note that many people may not exhibit noticeable or severe symptoms until their kidney disease has reached an advanced stage, which can complicate timely diagnosis and treatment.

However, you may become aware of one or more of the following symptoms:

• Feeling excessively tired and lacking energy, which can affect daily activities and overall quality of life.
• Experiencing difficulty concentrating, which may lead to challenges in work or school performance.
• Having a poor appetite, resulting in unintentional weight loss and nutritional deficiencies.
• Struggling with sleep disturbances, which can contribute to fatigue and exacerbate other symptoms.
• Encountering muscle cramping at night, causing discomfort and disrupting sleep.
• Noticing swelling in the feet and ankles, a condition known as edema, which can be uncomfortable and may indicate fluid retention.
• Observing puffiness around the eyes, particularly noticeable in the morning, which can be distressing and impact self-esteem.
• Experiencing dry and itchy skin, leading to discomfort and potential skin issues.
• Feeling the need to urinate more frequently, especially during the night, which can disrupt sleep and affect daily routines.

Upon receiving a diagnosis of chronic renal failure, your healthcare provider will engage in a detailed discussion regarding your treatment plan. This plan will be tailored to your individual health profile and the specific stage of your kidney disease, ensuring that the approach to treatment is both effective and appropriate for your needs.

Your treatment options may encompass one or more of the following:

• Blood pressure medication, which is crucial for managing hypertension that can exacerbate kidney damage.
• Cholesterol-lowering statins, aimed at reducing cardiovascular risks associated with chronic renal failure.
• Anaemia management, as kidney disease often leads to decreased production of red blood cells.
• Calcium and Vitamin D supplementation, which is important for maintaining bone health and preventing complications.
• A low protein diet, which can help reduce the burden on the kidneys and slow the progression of the disease.
• Dialysis, a procedure that artificially removes waste and excess fluid from the blood when the kidneys can no longer perform this function adequately.
• Kidney transplantation, which may be considered for eligible patients as a long-term solution for end-stage renal disease.

Momentum Medical Scheme’s chronic renal disease programme

This program is designed to provide members at risk of renal failure, or those currently experiencing renal failure or requiring transplant benefits, with access to specialized care. The program encompasses a wide range of support, including education on managing the condition, lifestyle modifications, medication management, dietary guidance, and options for haemodialysis, peritoneal dialysis, or kidney transplantation.

Focus on the chronic renal disease programme 2024

Who needs to register and how?

If you have been diagnosed with chronic renal disease by your treating physician and meet the necessary diagnostic criteria, you are required to register for the program. To initiate the registration process, ask your healthcare provider to complete the chronic renal application form. This form should be emailed to [e-mail], along with essential documentation, including:

• Pathology reports detailing your urea and electrolyte levels.
• A complete blood count and iron profile to assess your overall health status.
• A chronic prescription that includes relevant ICD-10 codes for accurate diagnosis categorization.

The chronic prescription must be sent to [e-mail]. If your application meets the established criteria, your chronic condition will be officially registered.

Chronic renal failure has a predetermined list of medications, referred to as a formulary, which are approved for treating the condition. Once your treatment plan is approved, your healthcare provider will be notified regarding whether the prescribed medication is included in the formulary and whether any copayment will be required.

Momentum Medical Scheme also offers a comprehensive treatment plan that encompasses all necessary visits to healthcare professionals, including renal dialysis technicians and dietitians, along with any investigations essential for managing your condition. Additional benefits may be allocated as needed to ensure you receive optimal care.

When you receive a prescription, it is important to take it to your pharmacist. Afterward, claims can be submitted for the approved chronic condition. If you select Associated as your chronic provider, you must obtain your chronic prescription from an Associated GP and acquire your chronic medication from Medipost. Should you choose to obtain your chronic medication from a pharmacy other than Medipost, please be aware that Momentum Medical Scheme will only reimburse 50% of the formulary price.

In the event that you require hospitalization due to your condition, you can log in to the Momentum App or reach out to us through the web chat feature on momentummedicalscheme.co.za. You can also email us at [e-mail], send a WhatsApp message, or call us at 0860 11 78 59 to request pre-authorization. A dedicated case manager will assist in coordinating your hospital stay to ensure a smooth process.

If you are enrolled in the Ingwe or Evolve Options, you are covered for Prescribed Minimum Benefits at State facilities. For those on the Custom, Incentive, or Extender Options who have selected State as their chronic provider, it is necessary to utilize State facilities for renal dialysis. In cases where chronic dialysis or treatment is unavailable or inaccessible at a State facility, you must provide a letter on the State facility's letterhead along with a motivation letter from your nephrologist. This documentation should be emailed to [e-mail] for review.

In situations where treatment options are not available, you will be informed of the outcome, including details about the authorized renal provider. This information will be provided during the pre-authorization stage to facilitate your care.

A dedicated Dialysis and Transplant Programme Coach will work closely with you and specialized clinical staff to ensure that you receive high-quality and effective care if you have been diagnosed with end-stage renal disease and require dialysis or transplantation. Dialysis is an ongoing process, and your treating physician can contact our call center annually to obtain an authorization number for continued treatment.

For any changes in your treatment type, a written motivation from your treating physician is required. This documentation can be emailed to [e-mail].

Focus on the chronic renal disease programme

Benefits of the chronic renal disease programme

The medications prescribed for chronic renal disease are covered under the Major Medical Benefit, subject to our formularies. A formulary is essentially a list of medications that are covered under your specific plan, from which your doctor can select the most suitable treatment for your condition.

Investigations and consultations related to chronic renal failure are also covered under the Major Medical Benefit. Each registered patient with chronic renal failure or those undergoing dialysis will receive a yearly treatment plan detailing all necessary procedures, investigations, and consultations required for effective management of their condition.

Member engagement and communication:

We are committed to maintaining open lines of communication with our members. We will reach out to you via telephone to encourage adherence to clinical care tailored to your health needs, working closely with your treating physician to ensure you receive the best possible support.

Provider profiling and communication:

Our focus is on identifying the most suitable general practitioners and specialists to provide you with high-quality and affordable care. This ensures that you have easier access to benefits that can help manage any complications arising from chronic renal disease. For more information regarding your chronic benefits, including where to obtain chronic medication and treatment, please visit this link.

Should you have any questions or require assistance, you can reach out to us via the web chat facility on momentummedicalscheme.co.za, email us at [e-mail], send us a WhatsApp message, or call us at 0860 11 78 59.

Glossary of terms Designated service providers:

Momentum Medical Scheme utilizes a network of designated service providers, including Associated GPs and specialists, as well as State facilities, to ensure our members receive appropriate diagnosis and treatment for Prescribed Minimum Benefits. A formulary is a list of medications covered under your plan, from which your healthcare provider can prescribe the suitable medication for your chronic condition. The ICD-10 refers to the diagnosis code used for categorization. Prescribed Minimum Benefits encompass a range of benefits that all medical schemes in South Africa are mandated to provide coverage for, as outlined in the Medical Schemes Act No 131 of 1998. These benefits include coverage for life-threatening emergency medical conditions, a defined set of 271 diagnoses, and 26 chronic conditions. Full benefits are available if you utilize the Scheme’s Designated Service Providers (DSPs). Should you choose to use non-designated service providers voluntarily, the Scheme will reimburse benefits up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. In the case of a life-threatening emergency where non-designated service providers are used, this is regarded as involuntary, and co-payments will be waived.