The diagnosed and the undiagnosed

A friend was on holiday in a small town when her baby’s scheduled immunisation was due. After being directed to the local clinic who had the stock of the required vaccination, she duly fell in line with other patients to open a new clinic file. Although it seemed that many patients waiting in the queue could read, the clinic assistant in charge was adamant on reading the questions and completing the forms on their behalf.

“Do you have disabilities?” It would thunder through the room, and so forth. By the time it was my friend’s turn, she insisted on reading the questions herself. And to her surprise, the “disabilities” everybody was questioned about, turned out to be “diabetes”. None of those in front of her had disabilities, but should they have been questioned correctly, they could have confirmed their diabetic status.

Among the top five most prevalent chronic conditions

Diabetes is one of the world’s fastest growing lifestyle diseases. In 2015 South Africa had 2.28 million cases of diabetes according to the International Diabetes Federation (IDF). The problem is that for every diagnosed adult, there is an estimated one undiagnosed adult. The number of undiagnosed cases in South Africa is projected at around 1.39 million.

Both diabetes mellitus types 1 and 2 rank among the top five most prevalent chronic conditions under medical scheme members.

Although it is one of the most prevalent conditions and the coverage ratio for medical scheme members with Diabetes mellitus Type 2 is slowly increasing, the coverage still seems to be low.

The proportion of Diabetes mellitus type 2 patients claiming for chronic disease medicine was a mere 28.8{915f2fd5aca4c3a34c5cb69d7973bd97975047c315a8e3a00cfb3db88c0fb71b} in 2015, the Council of Medical Schemes Annual Report shows.

The coverage of monitoring tests, such as the creatinine test was 33{915f2fd5aca4c3a34c5cb69d7973bd97975047c315a8e3a00cfb3db88c0fb71b} in 2015 and coverage for the HbA1c test was 26.2{915f2fd5aca4c3a34c5cb69d7973bd97975047c315a8e3a00cfb3db88c0fb71b}. It was at similar levels the previous years.

This is despite Diabetes insipidus and Diabetes mellitus types 1 and 2 being covered as chronic conditions under prescribed minimum benefits (PMBs). This means that medical schemes must cover costs of all members who suffers from diabetes, regardless of their benefit option.

Use your medical scheme benefits

Schemes usually have screening benefits to diagnose diabetes as well as wellness and chronic illness treatment programmes for affected members.

Plans for chronic conditions typically involve consultations with doctors, blood tests, treatments and medication.

“Diabetes treatment programmes generally include two GP consultations, which are often used to renew prescriptions for the next six months; 2 specialist consultations; and blood tests,” says Deon Heydenrych of Stapleford Insurance Brokers.

Even though an illness is a PMB, medical schemes can have their own cost-effective measures, such as lists of medication and designated service provider consultations which are covered without any excess.

This is where confusion about cover often kicks in. It means that if the scheme member decides to use a different service provider or medicine, the cost will only be covered up to a limit and the member will be responsible for the rest.

Heydenrych says it is also crucial that members register their chronic illness with the scheme. Only if you are registered as a chronic illness sufferer you will be able to receive all the benefits.

“If you need more than the provided two consultations or blood tests, your doctor can motivate a request that the scheme will cover the costs of those.”

To ensure that you don’t end up paying unnecessarily, it is also important that doctors provide the correct ICD-10 codes and procedure codes on accounts. These codes indicate which health conditions have been treated. If these are incorrect the fund may refuse to pay and the member will have to cover the costs out of their day to day benefits or own pocket.

Furry news on the diabetes front

Enter Honey, the first officially certified Medical Alert Dog to be trained in South Africa.

Medic Alert Dogs for diabetics are specifically trained to alert diabetic handlers in advance of low or high blood sugar events, before a dangerous situation can occur. In fact, by using their incredible sense of smell, these dogs can sniff out any changes in their owner’s glucose level up to 30 minutes before a blood glucose monitor.

Honey belongs to twelve-year-old Duncan Smuts, who was diagnosed with Type 1 diabetes when he was 3 years old. She has already woken him up due to a drop in his sugar levels.

With more training, her ability to detect the smell of a hypoglycaemic episode will become stronger and more reliable, says her trainer, Lucy Breytenbach, a behaviour practitioner with a BSc (Hons) degree in Animal Science, Behaviour and Welfare.

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