CALL 10177 IMMEDIATELY. Stroke is a time-critical emergency — every minute counts.
Do not drive yourself to hospital. Call 10177 or have someone drive you directly to the nearest hospital with a CT scanner and emergency unit.
Recognise a Stroke — FAST
F — Face drooping: One side of the face droops or is numb. Ask the person to smile — is the smile uneven? A — Arm weakness: One arm is weak or numb. Ask the person to raise both arms — does one drift downward? S — Speech difficulty: Slurred speech, unable to speak, or unable to understand speech. T — Time to call 10177. Do not wait to see if symptoms improve.
Additional warning signs: Sudden severe headache ("worst headache of my life" — subarachnoid haemorrhage), sudden vision loss in one or both eyes, sudden loss of balance or coordination, sudden confusion.
TIA (mini-stroke) also requires immediate ER attendance — do not wait because symptoms resolved. A TIA carries a 10–15% risk of full stroke within 48–90 days.
What Your Medical Aid Must Cover Right Now
Stroke is a PMB condition. Your scheme must fund emergency stroke treatment regardless of network, time of day, or pre-authorisation status.
| What is happening | PMB Coverage | Notes |
|---|---|---|
| Emergency ambulance (10177) | Yes — PMB | Do not delay calling because of cost |
| Emergency ER assessment + CT brain scan | Yes — PMB | CT is the critical first step — ischaemic vs haemorrhagic |
| IV thrombolysis (tPA) for ischaemic stroke | Yes — PMB | Must be within 4.5 hours of symptom onset |
| Mechanical thrombectomy (clot removal) | Yes — PMB | Large vessel occlusion — performed at specialised centres |
| ICU / HDU admission | Yes — PMB | Haemorrhagic stroke commonly requires ICU |
| Neurosurgery (haemorrhagic stroke) | Yes — PMB | Clipping/coiling of aneurysm; endovascular intervention |
| In-hospital physiotherapy, OT, speech therapy | Yes — PMB (acute admission) | Start as early as medically possible |
The critical fact: The treatment window for IV thrombolysis is 4.5 hours from symptom onset. Mechanical thrombectomy can be performed up to 24 hours in selected patients. Do not delay going to hospital.
Emergency Numbers
Ambulance (national): 10177 ER24: 084 124 Netcare 911: 082 911 Police: 10111 Poison & Emergency Centre (Tygerberg): 021 931 6129
At the Hospital — What to Say
When arriving at the ER, say immediately: "I think this person is having a stroke. When did symptoms start?"
The time of symptom onset is the most critical piece of clinical information. If you know the exact time, say it. If the person woke with symptoms, say "last known well" was when they went to bed.
Give the admissions desk your medical aid membership card and scheme details. In an emergency, treatment must not be withheld for administrative reasons — your PMB right is immediate.
If Your Scheme's Pre-Authorisation Is Slow
In a stroke emergency, do not wait for pre-authorisation. Go to hospital. Treatment cannot be delayed for administrative approval. Your scheme must cover emergency PMB treatment retrospectively if necessary.
A family member or carer should notify the scheme within 24–48 hours of the emergency admission. Most schemes have a 24-hour emergency authorisation line — this is different from the standard call centre.
After the Acute Crisis — If You Are Facing a Coverage Decline
If your scheme declines to fund any part of the acute stroke admission:
- Request written reasons immediately.
- Stroke is unambiguously a PMB DTP. Any refusal to fund acute stroke treatment is a potential PMB breach.
- Your treating neurologist should submit a clinical motivation referencing the stroke DTP and the PMB Regulations.
- Internal appeal — submit in writing with clinical notes.
- Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za. The CMS adjudicates PMB disputes; rulings are binding on schemes.
Post-Discharge Rehabilitation Declining — What to Do
If your scheme declines post-discharge physiotherapy, OT, or speech therapy:
- These are day-to-day benefits — if your annual allowance is exhausted, this is a benefits limit, not a PMB breach. Check your benefit balance first.
- If the decline is within your benefit period (earlier in the year), challenge the coding — ensure sessions are coded correctly to the stroke diagnosis (ICD-10: I63/I61/I64).
- Ask your treating therapist to write a clinical motivation letter for additional sessions beyond the standard allowance. Some schemes have a case management pathway for catastrophic conditions (including stroke) that can unlock additional rehabilitation benefits.
- Escalate to CMS if you believe a PMB benefit is being incorrectly denied.
Mental Health in Stroke Recovery
Post-stroke depression affects 30–40% of stroke survivors and significantly impairs rehabilitation outcomes. If you or your family member is experiencing persistent low mood, tearfulness, or hopelessness after stroke:
- Tell your neurologist or GP — depression is medically treatable and should be addressed as part of stroke recovery
- SADAG: 0800 567 567 (24-hour support line)
- Psychology sessions are funded from the day-to-day mental health benefit
Resources and Helplines
Emergency: 10177 (ambulance) | ER24: 084 124 | Netcare 911: 082 911 SA Stroke Foundation: strokesa.co.za SADAG: 0800 567 567 (24-hour) | sadag.org Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →