Emergency / crisis support: /emergency
If you are in an adrenal crisis, your medications are not being covered, or fludrocortisone is unavailable — these are the immediate steps.
Adrenal Crisis: Act Immediately
If you or someone with Addison's disease is collapsed, severely weak, vomiting uncontrollably, or confused and cannot communicate:
- Administer IM hydrocortisone 100mg immediately if the emergency kit is available and accessible.
- Call an ambulance — 10177 from a landline, 112 from a mobile phone.
- At hospital: say immediately — "This person has Addison's disease and needs IV hydrocortisone 100mg now." The MedicAlert bracelet communicates this if the patient is unconscious.
- Do not delay going to hospital while trying to reach the medical aid. Adrenal crisis is PMB — emergency care cannot be refused. Call the scheme retrospectively once the patient is stabilised.
- After the emergency, the hospital billing department will assist with obtaining retrospective pre-authorisation.
Common Addison's Disease Medical Aid Crises
1. Emergency kit not covered or difficult to access through the scheme 2. Fludrocortisone supply disruption — Florinef unavailable in SA 3. CDL medications charged to the MSA instead of the CDL benefit 4. Perioperative hydrocortisone coverage disputed post-surgery 5. DHEA supplement not covered under CDL benefit
If the Emergency Kit Is Refused
The IM hydrocortisone emergency kit is a safety-critical component of Addison's disease management. No competent endocrinologist would manage Addison's disease without prescribing this kit.
If the scheme refuses to fund it: 1. Ask your endocrinologist to submit a written clinical motivation stating that the emergency kit is a necessary and integral component of the safe management of Addison's disease, and that patient safety cannot be adequately maintained without access to parenteral hydrocortisone. 2. Purchase the kit privately in the interim — the safety imperative overrides the cost dispute. 3. Submit the receipt and motivation to the scheme for reimbursement. 4. If the scheme refuses reimbursement, escalate to the CMS citing the CDL obligation to fund "diagnosis, treatment, and care" of a CDL-listed condition.
If Fludrocortisone Is Unavailable
If your pharmacy cannot source Florinef (or equivalent): 1. Call your endocrinologist immediately — do not stop fludrocortisone without guidance. 2. Ask your pharmacist about specialist or compounding pharmacies that can source imported fludrocortisone. 3. Contact your scheme's pharmacy case management line and ask whether they can facilitate sourcing through a preferred pharmacy network. 4. During a supply gap, your endocrinologist may recommend increased dietary sodium as a partial compensatory measure — but this is not a substitute for fludrocortisone; it is an interim management step.
If CDL Medications Are on MSA
Register (or re-register) for the CDL benefit with the endocrinologist's current letter and ICD-10: E27.1. Request reprocessing of prior claims onto the CDL benefit. Hydrocortisone and fludrocortisone as adrenal replacement therapy for Addison's disease are textbook CDL medications. No scheme should be applying an MSA charge to standard adrenal replacement at correct doses.
If Perioperative Hydrocortisone Is Disputed
Before any surgery, confirm with your anaesthesiologist and your scheme that perioperative stress-dose hydrocortisone (typically IV hydrocortisone 50–100mg at induction, with tapering post-procedure) is pre-authorised. If the scheme disputes this claim post-surgery, submit the endocrinologist's letter confirming the Addison's diagnosis and the necessity of perioperative steroid cover. This is essential patient safety management for a CDL-registered condition — not an elective item.
Triage Table
| Situation | Priority | Action |
|---|---|---|
| Adrenal crisis | Emergency | IM hydrocortisone → ambulance → hospital; PMB covers emergency |
| Emergency kit refused | High | Endocrinologist motivation; purchase privately; CMS appeal |
| Fludrocortisone unavailable | High | Endocrinologist guidance; specialist pharmacy; scheme escalation |
| CDL meds on MSA | Medium | CDL registration + reprocessing |
| Perioperative hydrocortisone dispute | Medium | Endocrinologist letter + CDL claim dispute |
| DHEA not covered | Low | Exceptional-needs motivation; purchase privately if refused |
Preventing the Next Crisis
After a hospitalisation for adrenal crisis, the most important step is a frank conversation with your endocrinologist about what triggered the crisis and how to prevent the next one. Was there a medication supply gap? Was the sick day rule not applied quickly enough? Was there a triggering illness that was not recognised as requiring dose escalation?
Most crises are preventable with adequate patient education, proactive sick-day dosing, and a well-stocked emergency kit. Ask your endocrinologist whether a formal sick-day plan has been documented in your file, and ensure it is shared with anyone who might need to care for you in an emergency.
Escalation Contacts
Council for Medical Schemes (CMS): 0861 123 267 | www.medicalschemes.org.za AURA Emergency: /emergency
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This page is general information about medical schemes. It is not medical advice: speak to a healthcare professional about your own treatment. Medical aid and gap cover advice is given by Eldon de Waal, a Supervised Representative of Approach Administration (FSP 23579).