Focus on Addison’s disease

What is Addison's disease? Addison's disease is a hormonal disorder that affects the endocrine system, impacting individuals across all age groups and genders equally. This condition arises when the adrenal glands, which are responsible for producing essential hormones, fail to produce adequate amounts of cortisol. In certain cases, there may also be a deficiency in the hormone aldosterone. Addison's disease is sometimes referred to as adrenal insufficiency or hypocortisolism, highlighting the critical nature of the adrenal glands in maintaining hormonal balance and overall health.

The signs and symptoms of Addison's disease The symptoms associated with adrenal insufficiency typically develop gradually, making it crucial to recognize them early for effective management. Common symptoms include:

• Chronic fatigue: Individuals with Addison's disease often experience persistent tiredness that does not improve with rest. This fatigue can significantly impact daily activities and overall quality of life.
• Muscle weakness: Many patients report a noticeable decrease in muscle strength, which can hinder physical performance and lead to difficulties in performing routine tasks.
• Loss of appetite: A reduced desire to eat can result in unintended weight loss and nutritional deficiencies, further exacerbating the condition.
• Salt cravings: A strong desire for salty foods may occur due to the body’s need for sodium, which is often lost in excess through the urine.
• Weight loss: Unexplained weight loss is common, as the body struggles to maintain energy levels and proper metabolic function.
• Low blood pressure: Patients may experience hypotension, particularly when standing, leading to dizziness or fainting spells, which can pose significant risks.
• Gastrointestinal problems: Symptoms such as nausea, vomiting, and abdominal pain may arise, causing discomfort and complicating the management of the disease.

How to register on the chronic programme If you have received a diagnosis of Addison’s disease, it is important to take the next steps to ensure proper management. 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. Our chronic medicine consultant will collaborate with your healthcare provider to discuss and tailor your treatment plan. Once the necessary diagnostic criteria are satisfied and relevant blood tests have been submitted, your treatment will be approved. We will inform you if your prescribed treatment is covered under the Momentum Medical Scheme formulary or if any co-payment will be required. After receiving authorization, you can take your prescription to a designated service provider (DSP) to obtain your medication, and the claim can be submitted accordingly. A DSP is a healthcare provider—be it a doctor, pharmacist, or hospital—designated by the medical scheme as the preferred choice for members seeking diagnosis, treatment, or care for a Prescribed Minimum Benefit condition. Should you choose not to use the DSP and opt for a different provider, a co-payment may apply. It is also worth noting that authorizations typically expire after 12 months. If your medication remains unchanged, your doctor or pharmacist can renew the authorization by contacting us at 0860 11 78 59. This same process applies if there are any modifications or additions needed for your authorization.

For additional information regarding your chronic benefits and where to obtain chronic medications and treatments, please click here.

Hospitalisation In the event that you require hospitalization due to complications from cardiac failure, it is essential to secure pre-authorization. You can do this by logging into the Momentum App, utilizing the web chat feature on momentummedicalscheme.co.za, sending an email to [e-mail], sending a WhatsApp message, or calling us directly at 0860 11 78 59. Upon your request, we will assign a case manager to oversee and follow up on your hospitalization process.

Treatment plan Once you are registered in the Chronic Medicine Management Programme, you will gain access to a personalized treatment plan. This plan may encompass coverage for necessary tests, consultations with physicians, and other medically essential benefits as deemed appropriate by your healthcare provider. Our clinical team will review these benefits to ensure they meet the necessary standards for your health care.

Compliance Adhering to your treatment regimen is crucial for managing Addison's disease effectively. You are required to: obtain your chronic medication on a monthly basis, ensure that you take your medication precisely as prescribed by your doctor, and avoid missing any doses. Compliance is not only vital for maintaining your health but also for preventing serious complications that could arise from inconsistent medication intake.

Please make sure your claims have the appropriate ICD-10 code It is imperative that all claims submitted include the correct ICD-10 codes, which are diagnostic codes used to identify the claim accurately. This ensures that your claim can be processed and paid from the Chronic Benefit effectively.

We may pay claims from your Day-to-day Benefits if: There are certain circumstances under which claims may be paid from your Day-to-Day Benefits instead of the Chronic Benefit. This may occur if claims are submitted without the relevant ICD-10 codes, if you exceed the frequency limit on consultations or tests, or if the treatment is deemed not clinically appropriate.

Contact us Should you have any inquiries 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 Understanding the terminology related to your health coverage is essential. Designated service providers refer to a network utilized by the Momentum Medical Scheme, which includes associated general practitioners, specialists, and state facilities, to provide diagnosis and treatment for members concerning Prescribed Minimum Benefits.

A formulary is a comprehensive list of medications that are covered under your specific option, allowing your doctor to prescribe the most suitable medication for your chronic condition.

ICD-10 refers to the diagnosis code used for medical billing and record-keeping.

Prescribed Minimum Benefits constitute a set of benefits mandated for coverage by all medical schemes in South Africa, as outlined in the Medical Schemes Act 131 of 1998 and its corresponding regulations. To qualify for these benefits, your medical condition must be recognized as eligible and included in the defined list of conditions. Furthermore, the required treatment must align with the stipulated treatments within the defined benefits, and you must utilize the Scheme’s Designated Service Providers. If you opt for non-designated service providers voluntarily, benefits will be paid up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. However, if you require non-designated service providers in an emergency medical situation, this is regarded as involuntary, and co-payments will be waived.

If your medical condition and treatment do not satisfy the aforementioned criteria for accessing these benefits, we will process payments according to the benefits associated with your selected option.