CMScript 5 of 2023: Focus on Cholera
Medical schemes must pay for in and out-of-hospital consultations, tests, medicines, follow-up consultations and treatment in full for Cholera, if the services were obtained from a DSP. Services must be paid in full in emergencies, even if a non-DSP was used.
Cholera is an infectious diarrhoeal disease caused by a bacterium called Vibrio cholerae.
The period from which the person is infected to when they fall sick can be from a few hours to as long as 5 days. Most people infected experience very mild illness or do not feel ill at all. Mild cholera presents as a diarrhoeal illness which cannot easily be distinguished from other common causes of diarrhoea.
“Cholera” is a PMB condition under Diagnosis and Treatment Pair (DTP) code 338S. The treatment component specified for this DTP is “Medical management”. The medical schemes must pay for in and out-of-hospital consultations, tests, medicines, follow-up consultations and treatment in full if the services were obtained from a designated service provider (DSP).
In case of an emergency, healthcare services must be paid in full, even if a non-DSP was used. The healthcare practitioner must assist the member in completing the forms to register for PMB benefits which must be funded by the medical scheme from the risk-benefit. Funding of PMB claims from the Medical Savings Account (MSA) contravenes the Medical Schemes Act.
