Focus on bronchiectasis

What is Bronchiectasis?

Bronchiectasis is a medical condition characterized by the permanent damage to the bronchial tubes within the lungs. In this condition, these air passages become widened, enlarged, and thickened, leading to a significant alteration in their normal structure and function. As a result of this damage, the affected airways are unable to effectively clear mucus and bacteria, which can accumulate in the lungs. This accumulation creates an environment that is conducive to frequent infections and can lead to blockages in the airways, further complicating respiratory health.

There are two primary classifications of bronchiectasis based on the timing of its onset. When the condition is present from birth, it is referred to as congenital bronchiectasis. Conversely, if bronchiectasis develops later in life due to various factors, it is classified as acquired bronchiectasis.

The causes of bronchiectasis

Bronchiectasis can arise from any injury to the lungs, but the most prevalent cause is an infection within the lungs. This includes a range of infections, such as viral infections like influenza and bacterial infections like those caused by Staphylococcus or tuberculosis. However, there are several other potential causes of bronchiectasis that can contribute to its development. These include:

• Inhalation of foreign objects or food, which can cause physical damage to the airways.
• Breathing in stomach acid, which can occur in conditions like gastroesophageal reflux disease (GERD) and can irritate the lung tissues.
• Cystic fibrosis, a genetic disorder that affects the lungs and digestive system, leading to thick mucus production and subsequent lung damage.
• GORD (gastro-oesophageal reflux disease), which can lead to the aspiration of stomach contents into the lungs.
• Weakness in the immune system, such as that seen in individuals with HIV or uncontrolled diabetes, making them more susceptible to infections that can lead to bronchiectasis.

The symptoms of bronchiectasis

The symptoms associated with bronchiectasis may take a considerable amount of time to manifest, often developing over months or even years. Some of the common symptoms include:

• Chronic coughing, which may be persistent and bothersome.
• Coughing up blood, a concerning symptom that should be evaluated by a healthcare professional.
• Abnormal sounds or wheezing in the chest during breathing, indicating airway obstruction or irritation.
• Shortness of breath, which can significantly impact daily activities and quality of life.
• Chest pain, which may accompany breathing difficulties.
• Coughing up large quantities of mucus on a daily basis, which can be thick and discolored.
• Bad breath, which may arise from the accumulation of bacteria in the airways.
• Skin with a blue appearance, known as cyanosis, indicating low oxygen levels in the blood.
• Weight loss, which may occur due to chronic illness.
• Fatigue, a common symptom associated with many chronic diseases.
• Thickening of the skin under the nails and toes, known as clubbing, which can be a sign of chronic lung disease.

How to register on the chronic programme

If you receive a diagnosis of bronchiectasis, it is important to take the next steps in managing your condition. You should ask your doctor to reach out to our Chronic Medicine Department at 0860 11 78 59 to initiate your registration on the Chronic Medicine Management Programme. A consultant from the Chronic Medicine team will work closely with your physician to coordinate your treatment plan. Once all necessary diagnostic criteria have been satisfied and relevant x-rays and blood test results have been submitted, your treatment will be authorized. At this stage, we will inform you whether the prescribed treatment is covered under the Momentum Medical Scheme formulary or if you will be responsible for any co-payments.

Upon receiving authorization, you can take your prescription to your designated service provider to obtain your medication, and the claim can be processed. A designated service provider (DSP) refers to a healthcare professional, such as a doctor or pharmacist, or a medical facility that is preferred by the medical scheme for the diagnosis, treatment, or care of conditions classified as Prescribed Minimum Benefits. If you decide to seek treatment from a non-designated provider, you may incur additional co-payments.

It is important to note that the authorization typically expires after a period of 12 months. If your medication regimen remains unchanged, your doctor or pharmacist can contact us at 0860 11 78 59 to renew the authorization. This same process applies if there are any modifications or additions to your treatment plan.

For further details regarding your chronic benefits and how to access chronic medication and treatment, please refer to the information provided here.

Hospitalisation

In the event that you require hospitalization due to complications arising from bronchiectasis, you can easily request pre-authorization by logging into the Momentum App, utilizing the web chat feature on momentummedicalscheme.co.za, emailing us at [e-mail], sending a WhatsApp message, or calling us directly at 0860 11 78 59. After your request is submitted, we will assign a case manager to monitor and follow up on your hospital stay.

Treatment plan

Once you are officially registered in the programme, you will gain access to a comprehensive treatment plan. This plan may encompass coverage for various necessary medical tests, visits to healthcare providers, and other benefits deemed essential by your doctor. Each component of the treatment plan will be reviewed by our clinical team to ensure that it is appropriate and aligns with the standards of care.

Compliance

To effectively manage your condition and ensure optimal health outcomes, it is essential to adhere to the following guidelines:

• Obtain your chronic medication on a monthly basis to ensure that you have a consistent supply.
• Take your medication strictly according to the dosage and quantity prescribed by your healthcare provider, as this is crucial for effective treatment.
• Avoid missing any doses, as this can not only compromise your compliance but also lead to serious implications for your overall health and well-being.

Additionally, it is imperative that all claims submitted include the relevant ICD-10 codes. These diagnostic codes are necessary for accurately identifying and processing your claims under the Chronic Benefit.

We may pay claims from your Day-to-day Benefit if:

• The claims are submitted without the necessary ICD-10 codes.
• You exceed the frequency limit for consultations or tests.
• The treatment provided is not deemed clinically appropriate.

Contact us

If you have any questions or require assistance, you can reach out to us through the web chat feature 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: The Momentum Medical Scheme collaborates with a network of designated service providers, which includes associated general practitioners and specialists, as well as state facilities, depending on the specific circumstances. These providers are utilized for the diagnosis and treatment of our members concerning the Prescribed Minimum Benefits.

A formulary refers to a comprehensive list of medications that are covered under your specific medical plan. This list serves as a guide for doctors when prescribing the most appropriate medication for your chronic condition.

ICD-10 is the international classification of diseases code used for diagnosis.

Prescribed Minimum Benefits refers to a mandated list of benefits that all medical schemes in South Africa are required to cover as per the Medical Schemes Act 131 of 1998 and its associated regulations. To access these benefits, certain criteria must be met:

• Your medical condition must be recognized as qualifying for coverage and must be included in the defined list of Prescribed Minimum Benefit conditions.
• The treatment required must align with the treatments outlined in the defined benefits.
• You must utilize the Scheme’s Designated Service Providers. For more information about Designated Service Providers, please refer to the definition provided on page 2.

Should you voluntarily choose to seek treatment from non-designated service providers, the Scheme will cover benefits only up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. However, if you utilize non-designated service providers in emergency medical situations, this is considered involuntary, and co-payments will be waived.

If your medical condition and the treatment required do not meet the outlined criteria for accessing these benefits, we will process your claims according to the benefits associated with your selected benefit option.