Focus on multiple sclerosis

What is multiple sclerosis? Multiple sclerosis (MS) is recognized as one of the most prevalent neurological conditions globally. It affects the central nervous system, which includes the brain and spinal cord. Within this system, nerve cells are encased in a protective layer of protein known as myelin. This myelin sheath plays a crucial role in safeguarding the nerve fibers and ensuring that electrical signals generated in the brain can effectively transmit to various parts of the body. However, in individuals with MS, this protective myelin becomes compromised, leading to significant disruptions in the transmission of nerve signals. This disruption can result in a wide range of neurological issues and symptoms that can significantly impact a person's quality of life.

What are the types of multiple sclerosis? Multiple sclerosis is classified into four primary types, each characterized by different patterns of symptoms and progression. The most common form is remitting relapsing multiple sclerosis (RRMS). This type is marked by unpredictable episodes known as relapses, during which symptoms worsen or new symptoms appear. Following these relapses, patients may experience periods of remission that can last for months or even years, during which they may not exhibit any new signs of disease activity.

Secondary progressive multiple sclerosis (SPMS) is another form of MS that typically follows an initial course of RRMS. In SPMS, individuals begin to experience a gradual decline in neurological function between acute attacks, with fewer periods of remission. This means that while there may still be relapses, the overall trend is one of progressive deterioration.

Primary progressive multiple sclerosis (PPMS) is characterized by a steady progression of symptoms from the onset of the disease. Unlike RRMS, patients with PPMS do not experience relapses or only have minor remissions. Disability tends to develop early in the course of the disease, leading to a continuous decline in function.

Clinically isolated syndrome (CIS) refers to a situation where an individual experiences a single episode of neurological symptoms that last for at least 24 hours. While CIS can be a precursor to MS, not everyone who experiences CIS will go on to develop multiple sclerosis.

The signs and symptoms of multiple sclerosis can vary widely from person to person. Not all individuals with MS will exhibit the same symptoms, and the intensity of these symptoms can differ significantly among those affected. Common neurological signs and symptoms associated with MS may include:

• A reduced sense of touch, which can manifest as a diminished ability to feel sensations on the skin.
• Tingling or numbness in various parts of the body, often described as a "pins and needles" sensation.
• Muscle weakness, which may lead to difficulties with balance and coordination.
• Challenges with swallowing and speech, making communication and eating difficult.
• Emotional changes, including depression and anxiety, which can arise as a response to the challenges of living with MS.
• Visual disturbances, such as blurred or double vision, which can be indicative of optic neuritis, a condition associated with MS.
• Extreme fatigue, which is a common complaint among individuals with MS and can significantly impact daily activities.
• Bladder and bowel dysfunction, which can lead to incontinence or difficulty in controlling these bodily functions.
• Cognitive issues, including difficulties with thinking, planning, and learning new information.

Symptoms of MS often appear in episodic patterns, marked by acute and severe periods of worsening known as relapses. During these relapses, individuals may experience a noticeable decline in their neurological function. It is important to note that while some symptoms may be triggered by common factors such as infections—like the common cold or flu—many relapses occur without any identifiable trigger, making the disease unpredictable.

Possible causes of multiple sclerosis remain a topic of ongoing research. Although the exact cause of MS is still unclear, it is widely believed that a combination of environmental factors, genetic predispositions, and possibly other yet-to-be-identified factors contribute to the development of the disease. This multifactorial nature of MS complicates efforts to pinpoint a single cause, highlighting the need for continued investigation into the disease's etiology.

How to register on the chronic programme If you have received a diagnosis of Addison’s disease, it is essential to take the necessary steps to register for the Chronic Medicine Management Programme. To initiate this process, please ask your doctor to get in touch with our Chronic Medicine Department at 0860 11 78 59. A chronic medicine consultant will then coordinate with your physician regarding your treatment plan. After confirming that the diagnostic criteria have been met and relevant blood tests have been submitted, your treatment will be approved. You will be informed whether your prescribed treatment is included in the Momentum Medical Scheme formulary or if you will be required to make a co-payment. Once you receive authorization, you can present your prescription to your designated service provider to obtain your medication, and a claim can subsequently be submitted for reimbursement. A designated service provider (DSP) is a healthcare professional, such as a doctor, pharmacist, or hospital, that is preferred by the medical scheme for managing conditions classified as Prescribed Minimum Benefits. Should you choose not to use a DSP and opt for a different healthcare provider, a co-payment may be applicable. Typically, the authorization for treatment will expire after 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. This same process will be followed if there are any modifications or additions to your treatment plan.

For more 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 related to cardiac failure, it is important to follow the proper procedures for pre-authorization. You can log in to the Momentum App, utilize the web chat feature on momentummedicalscheme.co.za, send us an email at [e-mail], send a WhatsApp message, or call us directly at 0860 11 78 59 to request pre-authorization for your hospitalization. Upon your request, we will assign a case manager who will follow up on your hospital stay to ensure that everything proceeds smoothly.

Treatment plan Once you are successfully registered on the programme, you will gain access to a comprehensive treatment plan. This plan may encompass coverage for various necessary tests, consultations with healthcare providers, or other benefits deemed medically essential by your doctor. Our clinical team will review all aspects of your treatment to ensure that they are appropriate and aligned with your healthcare needs.

Compliance It is imperative that you adhere to the following guidelines to ensure effective management of your condition:

• Obtain your chronic medication on a monthly basis to maintain a consistent treatment regimen.
• Take your medication strictly according to the dosage and quantity prescribed by your healthcare provider.
• Ensure that you do not miss any doses, as this is critical 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 that all claims submitted for reimbursement include the correct ICD-10 codes (diagnostic codes). These codes enable us to accurately identify and process the claims from the Chronic Benefit, ensuring that you receive the appropriate coverage.

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 allowed frequency limit for consultations or tests.
• The treatment provided is not deemed clinically appropriate.

Contact us Should you have any questions or need assistance, you can reach out to us via the web chat feature on momentummedicalscheme.co.za, email us at [e-mail], send 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 (GPs), specialists, and state facilities. These providers are selected to diagnose and treat members for conditions classified as Prescribed Minimum Benefits.

A formulary is defined as a comprehensive list of medications that are covered under your specific medical plan. From this list, a doctor can prescribe the most appropriate medication to manage your chronic condition effectively.

ICD-10 is the standard diagnosis coding system used to categorize and identify medical diagnoses.

Prescribed Minimum Benefits refer to a set of essential health benefits that all medical schemes in South Africa are mandated to cover according to 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 included in the defined list of Prescribed Minimum Benefit conditions.
• The treatment required must align with the treatments specified in the defined benefits.
• You must utilize the Scheme’s Designated Service Providers. For further 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 cover benefits only up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. In cases of emergency medical conditions where non-designated service providers are utilized, this is considered involuntary, and co-payments will be waived.