Focus on bronchiectasis

What is Bronchiectasis?

Bronchiectasis is a medical condition characterized by the permanent damage and abnormal enlargement of the bronchial tubes within the lungs. This damage leads to the thickening and widening of these air passages, which can significantly impact respiratory function. The compromised state of the bronchial tubes creates an environment conducive to the accumulation of bacteria and mucus, resulting in frequent lung infections and blockages in the airways. When bronchiectasis is present from birth, it is referred to as congenital bronchiectasis. Conversely, if the condition 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 a lung infection. Such infections can be viral, like influenza, or bacterial, such as those caused by staphylococcus or tuberculosis. Beyond infections, there are several other potential causes of bronchiectasis that can contribute to its development. These include the inhalation of foreign objects or food particles, which can obstruct airways and lead to inflammation. Additionally, breathing in stomach acid, often due to gastro-oesophageal reflux disease (GORD), can damage the bronchial tubes. Other significant contributors to bronchiectasis include cystic fibrosis, a genetic disorder that affects the lungs and digestive system, and conditions that weaken the immune system, such as HIV or poorly controlled diabetes. Each of these factors can lead to the chronic inflammation and damage that characterize bronchiectasis.

The symptoms of bronchiectasis

The symptoms associated with bronchiectasis may develop gradually, often taking months or even years to become apparent. Individuals with this condition may experience a variety of symptoms that can significantly affect their quality of life. Chronic coughing is one of the most common symptoms, often accompanied by the coughing up of blood in some cases. Patients may also notice abnormal sounds or wheezing in the chest while breathing, which can indicate airway obstruction. Other symptoms include shortness of breath, which can occur even with minimal exertion, and chest pain that may arise from the strain on respiratory muscles. Many individuals with bronchiectasis report coughing up large amounts of mucus on a daily basis, which can be both uncomfortable and socially distressing. Additionally, some may experience bad breath due to the accumulation of bacteria in the airways. Other physical signs of the condition may include a bluish tint to the skin, weight loss, fatigue, and thickening of the skin under the nails and toes. These symptoms collectively highlight the impact of bronchiectasis on an individual's overall health and well-being.

How to register on the chronic programme

After receiving a diagnosis of bronchiectasis, it is essential to take the next step in managing the condition by registering for the Chronic Medicine Management Programme. To initiate this process, please ask your doctor to reach out to our Chronic Medicine Department at 0860 11 78 59. The consultant from the Chronic Medicine team will collaborate with your healthcare provider to develop an appropriate treatment plan tailored to your needs. Once the necessary diagnostic criteria have been met and relevant x-rays and blood test results have been submitted, the proposed treatment will be reviewed and approved. You will be informed whether your treatment is covered under the Momentum Medical Scheme formulary or if a co-payment will be required.

Upon receiving authorization for your treatment, you can take your prescription to a designated service provider to obtain your medication. A designated service provider (DSP) refers to healthcare professionals, such as doctors, pharmacists, or hospitals, that are preferred by the medical scheme for the diagnosis, treatment, or care of conditions classified under the Prescribed Minimum Benefits. It is important to note that if you choose not to use a DSP and opt for a different healthcare provider, you may be subject to additional co-payments.

Authorization for treatment typically remains valid for a period of 12 months. If there are no changes to the medication you require, your doctor or pharmacist can contact us at 0860 11 78 59 to renew the authorization. This process also applies in cases where there are modifications or additions to your treatment plan. For more information about your chronic benefits and how to access chronic medication and treatment, please click here.

Hospitalisation

In the event that you require hospitalization due to complications from cardiac failure, it is crucial to take immediate action. You can log into the Momentum App for assistance, or you may contact us through the web chat feature available on momentummedicalscheme.co.za. Alternatively, you can reach out via email at [e-mail], send us a WhatsApp message, or call us directly at 0860 11 78 59 to request pre-authorisation for your hospitalization. Upon your request, we will assign a case manager to oversee and follow up on your hospital stay, ensuring that you receive the necessary care and support during this time.

Treatment plan

Once you are successfully registered in the Chronic Medicine Management Programme, you will gain access to a comprehensive treatment plan. This plan may encompass coverage for various medical necessities such as diagnostic tests, visits to healthcare providers, and other benefits that your doctor deems medically necessary. Each component of the treatment plan will be carefully reviewed by our clinical team to ensure its appropriateness and alignment with your health needs.

Compliance

To effectively manage your bronchiectasis, it is imperative to adhere to your treatment plan diligently. This includes obtaining your chronic medication on a monthly basis, ensuring that you take your medication exactly as prescribed by your doctor, and being vigilant about not missing any doses. Adhering to these guidelines is not only crucial for compliance with your treatment but also significantly impacts your overall health and well-being. Missing doses can lead to serious health complications, so it is essential to prioritize your medication regimen.

Please make sure your claims have the appropriate ICD-10 code

When submitting claims for your treatment, it is vital to include the appropriate ICD-10 codes, which serve as diagnostic codes. These codes allow us to accurately identify and process your claim under the Chronic Benefit. Ensuring that your claims are correctly coded is essential for timely and proper reimbursement.

We may pay claims from your Day-to-day Benefits 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 deemed clinically appropriate.

Contact us

If you have any questions or need assistance, you can reach out to us through the web chat feature available on momentummedicalscheme.co.za. You can also email us at [e-mail], send us a WhatsApp message, or call us at 0860 11 78 59. We are here to help you with all your inquiries and support you in managing your health effectively.

Glossary of terms

Designated service providers are part of the Momentum Medical Scheme's network, which includes a range of healthcare professionals such as associated general practitioners and specialists, as well as state facilities. These providers are selected to diagnose and treat members for conditions that fall under the Prescribed Minimum Benefits.

A formulary is essentially a list of medications that are covered under your specific medical scheme option. This list guides your healthcare provider in prescribing the appropriate medications for your chronic condition.

ICD-10 refers to the International Classification of Diseases, 10th Revision, which is the standardized diagnosis coding system used to categorize diseases and health conditions.

Prescribed Minimum Benefits encompass a set of essential health benefits that all medical schemes in South Africa are mandated to provide coverage for, as outlined in the Medical Schemes Act 131 of 1998. These benefits include life-threatening emergency medical conditions, a defined list of 271 diagnoses, and 26 chronic conditions. When utilizing the Scheme’s Designated Service Providers (DSPs), these benefits are covered in full. 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 may apply. It is important to note that if non-designated service providers are used in a life-threatening emergency, the situation is considered involuntary, and co-payments will be waived.