A significant achievement for the QASA community and all with spinal cord injuries (SCI) as the funding of care for bladder management, including catheterization, changes
Historically, those relying on medical aids have been challenged with uncertainty regarding health care benefits, which was further complicated by medical aid interpreting these benefits differently. This resulted in inconsistent coverage and, worse still, potential complications. Now, through the Clinical Advisory Panel (CAP) set up by QASA a decade ago, a breakthrough has been achieved!
The Council for Medical Schemes (CMS) regulates the activities of medical aids, determines overall policy and coordinates the development of benefit definition guidelines for each Prescribed Minimum Benefit (PMB) package.
With the participation of CAP, the CMS has published a new Benefit Definition Guideline covering the assessment, diagnosis, treatment and management of Neurogenic Bladder Dysfunction, and makes recommendations and suggestions to enhance the overall care of individuals with SCI-related bladder dysfunction.
The primary objective of these guidelines is to improve clarity in the funding decisions by medical schemes and provide clear, comprehensive descriptions of your benefits to ensure that all medical aid members have access to certain minimum health services – the aim of which is to provide continuous and affordable care to improve and maintain health.
These guidelines are based on the best available evidence of clinical and cost effectiveness in the context of South Africa, and intended to guide interpretation by relevant stakeholders, which include the beneficiary (patient), provider (doctor) and payer (medical aid), of these benefit provisions.
What this means to you is clarity and certainty with respect receiving the care and coverage that you need and deserve, provided for under the medical aid plan that you currently have. You can find the new CMS Benefit Guideline on Neurogenic Bladder Management here.
