Focus on hypertension

What is hypertension? Hypertension, commonly referred to as high blood pressure, is a prevalent medical condition characterized by the persistent elevation of blood pressure against the walls of the arteries. Over time, this sustained pressure can lead to serious health complications, including heart disease. Blood pressure is influenced by two main factors: the volume of blood that the heart pumps and the resistance that the blood encounters as it flows through the arteries. Essentially, the more blood the heart pumps and the narrower the arteries become, the higher the blood pressure will be. Understanding these dynamics is crucial in managing and preventing hypertension effectively.

The signs and symptoms of hypertension Most individuals suffering from high blood pressure are often unaware of their condition, as it typically does not present any noticeable signs or symptoms, even when readings reach dangerously elevated levels. While a small percentage of people may experience symptoms such as headaches, shortness of breath, or nosebleeds, these manifestations are not specific to hypertension and usually only occur when blood pressure has escalated to a severe or life-threatening stage. This lack of obvious symptoms is why hypertension is often referred to as a "silent killer," making regular monitoring essential for early detection and management.

Possible causes of hypertension

Primary (essential) hypertension: In the case of primary hypertension, which is the most common type, there is typically no identifiable cause for the elevated blood pressure. This condition tends to develop gradually over many years and is influenced by a combination of genetic, environmental, and lifestyle factors. Understanding the underlying risk factors can help individuals take proactive measures to manage their blood pressure effectively.

Secondary hypertension: Unlike primary hypertension, secondary hypertension is often linked to an underlying health condition. This type of high blood pressure can develop suddenly and usually results in more severe hypertension compared to primary hypertension. Various medical conditions and certain medications can contribute to the onset of secondary hypertension. Some potential causes include:

• Obstructive sleep apnea: This sleep disorder, characterized by repeated interruptions in breathing during sleep, can significantly raise blood pressure.
• Kidney problems: Conditions affecting the kidneys can disrupt the body’s ability to regulate blood pressure, leading to hypertension.
• Adrenal gland tumors: These tumors can cause the adrenal glands to produce excess hormones that elevate blood pressure.
• Thyroid problems: An overactive or underactive thyroid can influence blood pressure levels.
• Congenital defects in blood vessels: Some individuals may be born with structural abnormalities in their blood vessels that can lead to hypertension.
• Certain medications: Some drugs, including birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and certain prescription medications, can raise blood pressure.
• Illegal drugs: Substances such as cocaine and amphetamines are known to cause significant increases in blood pressure.
• Alcohol abuse or chronic alcohol use: Prolonged excessive alcohol consumption can lead to elevated blood pressure levels.

How to register on the chronic programme If you have been diagnosed with Addison’s disease, it is important to initiate the registration process for the Chronic Medicine Management Programme. You should ask your doctor to reach out to our Chronic Medicine Department at 0860 11 78 59. The consultant will work closely with your physician to coordinate your treatment plan. Once the necessary diagnostic criteria are met and blood test results are submitted, your treatment will be evaluated and approved. We will inform you whether your treatment is covered under the Momentum Medical Scheme formulary or if a co-payment is required. After receiving authorization, you can present your prescription at your designated service provider to obtain your medication, and the claim will be processed accordingly. A designated service provider (DSP) is a healthcare professional, such as a doctor, pharmacist, or hospital, that the medical scheme prefers for members seeking diagnosis, treatment, or care for a Prescribed Minimum Benefit condition. If you choose to go to a different provider instead of the DSP, a co-payment may apply. Please note that authorizations typically expire after 12 months, but if your medication remains unchanged, your doctor or pharmacist can renew the authorization by contacting us at 0860 11 78 59. The same renewal process applies if there are any modifications or additions to your treatment plan.

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

Hospitalisation If hospitalization is necessary due to complications from cardiac failure, you should log in to the Momentum App or reach out to us using the web chat feature available 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 case manager will be assigned to monitor your hospital stay and ensure that your needs are addressed promptly.

Treatment plan Upon successful registration in the programme, you will gain access to a comprehensive treatment plan that may encompass coverage for necessary tests, medical consultations, and other benefits deemed essential by your healthcare provider. Our clinical team will review these benefits to ensure they are appropriate and align with your medical needs.

Compliance It is crucial for you to adhere to the following guidelines to ensure effective management of your condition: You must obtain your chronic medication on a monthly basis to maintain a consistent treatment regimen. It is essential to take your medication precisely as prescribed by your doctor, adhering to the recommended dosage and quantity. Do not skip doses, as this could not only compromise your treatment compliance but also have serious repercussions for your overall health and well-being.

Please make sure your claims have the appropriate ICD-10 code Ensuring that all claims include the correct ICD-10 codes (diagnostic codes) is vital for accurately identifying and processing your claims under the Chronic Benefit. Without these codes, there may be delays or issues with reimbursement.

We may pay claims from your Day-to-day Benefits if: The claims are submitted without the necessary ICD-10 codes. You have exceeded the allowed frequency for consultations or tests. The treatment provided is deemed not clinically appropriate.

Contact us Should you have any questions or require assistance, feel free to reach out to us via the web chat feature on momentummedicalscheme.co.za, email us at [e-mail], send a WhatsApp message, or simply 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 may include associated general practitioners and specialists, as well as state facilities, depending on the specific circumstances. These providers are selected to ensure that our members receive appropriate diagnosis and treatment for their Prescribed Minimum Benefits.

A formulary: This refers to a list of medications that are covered under your specific medical scheme option, from which your doctor can prescribe the most suitable medication for your chronic condition.

ICD-10: This is the code used for diagnosing medical conditions, known as the International Classification of Diseases, 10th Revision.

Prescribed Minimum Benefits: This term encompasses a list of essential benefits that all medical schemes in South Africa are required to provide coverage for, as mandated by the Medical Schemes Act 131 of 1998 and its accompanying regulations. To qualify for these benefits, your medical condition must meet specific criteria and be included in the defined list of Prescribed Minimum Benefit conditions. Additionally, the required treatment must align with the treatments specified in the defined benefits, and you must utilize the Scheme’s Designated Service Providers. For more information on Designated Service Providers, please refer to the definition provided on page 2.

If 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. However, if you require services from non-designated providers due to an emergency medical condition, this is considered involuntary, and co-payments will be waived.