Focus on ulcerative colitis

What is ulcerative colitis?

Ulcerative colitis is classified as an inflammatory bowel disease (IBD) that affects the gastrointestinal (GI) tract. This chronic condition is characterized by inflammation and the formation of sores, known as ulcers, on the inner lining of the large intestine. It is important to note that ulcerative colitis is not the only form of IBD; Crohn's disease and microscopic colitis are two other prevalent types. The symptoms associated with ulcerative colitis can vary widely, ranging from mild to severe, and they typically develop gradually, often worsening over time. Patients with this condition may experience alternating periods of exacerbation and remission, during which they have no symptoms. The primary objective of treatment for ulcerative colitis is to prolong these remission phases, allowing individuals to lead a more comfortable life.

Most individuals diagnosed with ulcerative colitis are under the care of a gastroenterologist, a medical professional who specializes in diseases affecting the digestive system.

The signs and symptoms of ulcerative colitis

The symptoms of ulcerative colitis can differ based on the location and severity of the inflammation within the intestine. The most frequently observed symptoms include diarrhea that may contain blood or pus, along with abdominal discomfort, which can be quite distressing for those affected.

Other signs and symptoms include:

• An urgent need for a bowel movement, which can be both sudden and overwhelming, leading to anxiety about being away from a restroom.
• Feelings of fatigue, which can be debilitating and may result from the body’s struggle to absorb nutrients properly.
• Nausea or loss of appetite, making it difficult for individuals to maintain a balanced diet.
• Weight loss, which can occur due to decreased food intake or malabsorption of nutrients.
• Fever, which may indicate an underlying inflammatory process or infection.
• Anaemia, a condition characterized by a reduced number of red blood cells, leading to fatigue and weakness.

Less common symptoms include:

• Joint pain or soreness, which may be a result of inflammation affecting not just the intestines but also the joints.
• Eye irritation, which can manifest as redness, pain, or vision changes.
• Certain skin rashes, which may appear as a result of the inflammatory processes in the body.

Possible causes of ulcerative colitis

The precise cause of ulcerative colitis remains unknown, despite ongoing research. However, several factors are believed to contribute to its development. These include:

• An overactive intestinal immune system, which can mistakenly attack the body’s own tissues, leading to inflammation and ulceration.
• Genetic predisposition, as individuals with a family history of ulcerative colitis may be at higher risk of developing the condition.
• Environmental factors, which might include dietary influences, exposure to certain infections, or other external triggers that could initiate or exacerbate symptoms.

How to register on the chronic programme

If you have received a diagnosis of ulcerative colitis, it is important to take the next step by asking your doctor to contact our Chronic Medicine Department at 0860 11 78 59. This will initiate your registration on the Chronic Medicine Management Programme. A chronic medicine consultant will collaborate with your healthcare provider to ensure that your treatment plan is appropriately managed. After the necessary diagnostic criteria have been satisfied and relevant blood tests have been completed, your treatment will be approved. You will be informed whether your prescribed treatment is covered under the Momentum Medical Scheme formulary or if a co-payment will be required. Once you have received authorization, you can present your prescription to your designated service provider to obtain your medication, and the claim can subsequently be submitted for processing. A designated service provider (DSP) is a healthcare professional—such as a doctor, pharmacist, or hospital—who is the preferred choice for the medical scheme’s members when they require diagnosis, treatment, or care for a condition classified under the Prescribed Minimum Benefits. If you choose not to use the DSP and opt for a different healthcare provider, there may be a co-payment involved. Typically, the authorization will remain valid for a period of 12 months. If there are no changes to your prescribed medication, your doctor or pharmacist can renew the authorization by contacting us at 0860 11 78 59. This same process will apply if there are any modifications or additions to your treatment plan.

For further details regarding your chronic benefits and information on 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 log in to 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 a WhatsApp message, or call us at 0860 11 78 59 to request pre-authorization for your hospital stay. Upon your request, we will assign a case manager to oversee and follow up on your hospital admission.

Treatment plan

Once you are successfully registered on the chronic programme, you will gain access to a comprehensive treatment plan. This plan may encompass coverage for necessary tests, consultations with healthcare providers, and other benefits deemed medically essential by your doctor. Each aspect of the treatment plan will be carefully reviewed by our clinical team to ensure that it is appropriate and aligned with your health needs.

Compliance

To maintain your health and effectively manage your condition, it is crucial that you adhere to the following compliance measures:

• Obtain your chronic medication consistently on a monthly basis, ensuring that you do not run out of your necessary treatments.
• Take your medication exactly as prescribed by your doctor, adhering to the specified dosage and quantity to achieve the best results.
• Avoid missing doses, as this is vital not only for maintaining compliance but also to prevent any serious implications for your overall health and well-being.

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 that help us accurately identify and process your claim from the Chronic Benefit. This ensures that your claims are handled efficiently and appropriately.

We may pay claims from your Day-to-day Benefits if:

• The claims are submitted without the relevant ICD-10 codes, which can lead to delays or denials in processing.
• You have exceeded the frequency limit on consultations or tests, which may result in costs being covered under different benefit categories.
• The treatment is determined to be clinically inappropriate, which can impact the approval of claims.

Contact us

If you need assistance or have questions, you can reach out to us via the web chat feature on momentummedicalscheme.co.za. You may also email us at [e-mail], send a WhatsApp message, or call us at 0860 11 78 59.

Glossary of terms

Designated service providers refer to the network of healthcare professionals that the Momentum Medical Scheme utilizes, which includes associated general practitioners and specialists, as well as state facilities, depending on the specific circumstances surrounding the treatment of our members for Prescribed Minimum Benefits.

A formulary is defined as 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 stands for the International Classification of Diseases, 10th Revision, which is used as a diagnostic coding system.

Prescribed Minimum Benefits represent a set of benefits that all medical schemes in South Africa are mandated to cover under the Medical Schemes Act 131 of 1998 and its associated regulations. To qualify for these benefits:

• Your medical condition must meet the criteria for coverage and be included in the defined list of 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 further details on Designated Service Providers, refer to the definition provided on page 2. If you opt to use non-designated service providers voluntarily, the Scheme will only cover benefits up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. However, if you utilize non-designated service providers in cases of an emergency medical condition, this is considered involuntary, and co-payments are therefore waived.