Focus on haemophilia

What is haemophilia?

Haemophilia is a rare medical condition characterized by the inability of the blood to clot properly due to a deficiency in certain blood-clotting proteins known as clotting factors. Individuals diagnosed with haemophilia tend to experience prolonged bleeding after sustaining injuries compared to those with normal clotting abilities. While minor cuts and scrapes may not pose significant issues, the real danger lies in the potential for deep internal bleeding, particularly in areas such as the knees, ankles, and elbows. Such internal bleeding can inflict damage on vital organs and tissues, and in severe cases, it can become life-threatening.

Haemophilia is primarily an inherited genetic disorder, and as of now, there is no definitive cure available. Nevertheless, with appropriate medical treatment and diligent self-care, most individuals living with haemophilia can lead active and fulfilling lives, participating in daily activities and maintaining productivity.

What are the causes of haemophilia? Haemophilia is generally inherited, but it is important to note that approximately 30 percent of individuals diagnosed with this condition do not have a family history of it. In these cases, haemophilia arises from a genetic alteration known as a spontaneous mutation. There are several distinct types of haemophilia, classified based on the specific clotting factor that is deficient in the individual’s blood. The three main types include: Haemophilia A: This is the most prevalent form of the disorder, resulting from a deficiency in clotting factor VIII.Haemophilia B: The second most common type, which occurs due to insufficient levels of clotting factor IX.Haemophilia C: This type is often associated with milder symptoms and is caused by a deficiency in clotting factor XI.

The symptoms of haemophilia can manifest in various ways, particularly through spontaneous bleeding episodes. Common signs and symptoms include: Unexplained and excessive bleeding from cuts or injuries, or following surgical procedures or dental work.The presence of large or deep bruises that appear without a clear cause.Unusual bleeding episodes after receiving vaccinations.Pain, swelling, or a feeling of tightness in the joints.Blood present in urine or stool.Nosebleeds that occur without any identifiable reason.Intracranial haemorrhage, which is bleeding within the brain or skull, may lead to symptoms such as nausea, vomiting, and lethargy.

How to register on the chronic programme If you have received a diagnosis of Addison’s disease, it is essential to request that your doctor 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 collaborate with your physician regarding your treatment plan. Once the necessary diagnostic criteria have been satisfied and relevant blood test results are submitted, your treatment will be authorized. We will inform you whether your treatment is covered under the Momentum Medical Scheme formulary or if you will be required to make a co-payment. After receiving authorization, you can take your prescription to your designated service provider to obtain your medication, and the claim can then be submitted. A designated service provider (DSP) refers to healthcare professionals such as doctors, pharmacists, or hospitals that are preferred by the medical scheme when members need diagnosis, treatment, or care for a Prescribed Minimum Benefit condition. Should you choose not to utilize the DSP and opt for another hospital, doctor, or pharmacy, a co-payment may be applicable. Typically, the authorization remains valid for a period of 12 months. If there are no changes in the medication you require, your doctor or pharmacist can contact us at 0860 11 78 59 to renew the authorization. The same procedure applies if there are any modifications or additions to your authorization.

For more information regarding your chronic benefits and where to access chronic medication and treatment, please click here.

Hospitalisation In the event that you require hospitalization due to complications arising from cardiac failure, you can log into the Momentum App, or reach out to us through the web chat feature available on momentummedicalscheme.co.za. Alternatively, you can email us at [e-mail], send us a message via WhatsApp, or call us at 0860 11 78 59 to request pre-authorization. A case manager will be assigned to monitor and follow up on your hospitalization.

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 necessary tests, visits to doctors, or other benefits deemed medically essential by your healthcare provider. All proposed treatments will be evaluated by our clinical team to ensure their appropriateness and effectiveness.

Compliance It is crucial for you to adhere to the following guidelines: Acquire your chronic medication on a monthly basis.Ensure that you take your medication according to the prescribed dosage and quantity as directed by your doctor.Be diligent in not missing any doses, as this is vital not only for maintaining compliance but also for safeguarding your overall health and well-being.

Please make sure your claims have the appropriate ICD-10 code It is essential for all claims to include the correct ICD-10 codes, which serve as diagnostic codes. This ensures that we can accurately identify and process the claim from the Chronic Benefit.

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 for consultations or tests.The treatment provided is not considered clinically appropriate.

Contact us If you need assistance, feel free to reach out to us via 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: Momentum Medical Scheme operates a network of designated service providers, including associated general practitioners and specialists, as well as state facilities, based on the specific circumstances, to effectively diagnose and treat our members for the Prescribed Minimum Benefits.A formulary: This refers to a comprehensive list of medications that are covered under your plan, from which your doctor can prescribe the appropriate treatment for your chronic condition.ICD-10: This is the standardized code used for diagnoses.Prescribed Minimum Benefits: This is a set of benefits that all medical schemes in South Africa are mandated to provide coverage for, as outlined in the Medical Schemes Act 131 of 1998 and its associated regulations. To access these benefits, certain criteria must be met: Your medical condition must qualify for coverage and be listed among the defined Prescribed Minimum Benefit conditions.The required treatment must align with the treatments specified in the defined benefits.You must utilize the Scheme’s Designated Service Providers. For additional information regarding Designated Service Providers, please refer to the definition on page 2.

If you voluntarily opt to use non-designated service providers, the Scheme will reimburse benefits up to the Momentum Medical Scheme Rate, and relevant co-payments will be applicable. However, if non-designated service providers are used in emergency medical situations, it is regarded as involuntary, and co-payments will be waived.