Will My Medical Aid Pay For Rehab?

Private addiction treatment can be quite expensive! Read more about how We Do Recover can help you claim from your medical aid for rehab.

Will My Medical Aid Pay For Drug or Alcohol Rehab In South Africa?

Private addiction treatment can be costly, so utilising medical insurance can be extremely beneficial. In South Africa, most medical aid funds cover drug rehab if the treatment center is licensed by the Department of Social Development. However, coverage depends on your specific medical aid fund. To get more information, you can contact us at 081-444-7000 or check here for medical aid details. Another method is to directly contact the rehab center and inquire if they have experience with patients on your medical aid and if there have been any issues with insurance claims.

Medical aids recognise the complexity of addiction treatment. They may have preferences for certain rehab centers based on positive past experiences. It’s important to find out if your medical aid recommends specific clinics or if they allow you the freedom to choose any addiction treatment center.

Effective drug rehab must address the underlying core issues of addiction. Substance abuse is a disorder with both psychological and physical aspects and medical aids are aware that addressing both is fundamental for successful treatment.

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Frequent Questions

Addiction can become a complex issue, dealing with loved ones and relationships that are in turmoil. We are here to help navigate the path with you.

Frequent Questions About Addiction

Will medical aid pay for alcohol / drug rehab?

When selecting an addiction treatment center in South Africa, it’s essential to ensure they have the capacity to provide your medical aid with the necessary information for payment processing. Typically, medical aids require a formal diagnosis from a doctor, psychiatrist or psychologist before agreeing to cover your treatment costs. A rehab center offering a comprehensive program should be able to furnish all required documentation for medical aid coverage and work-related purposes.

Most South African medical aids limit coverage to the initial weeks of treatment at a registered drug rehab facility. Despite the improved outcomes with extended care, medical aids generally don’t cover beyond the initial treatment phase.

Fortunately, South Africa has a range of affordable drug rehab options and medical aid can make some of the more expensive facilities accessible to the middle class. If you need assistance finding a registered drug rehab clinic, please feel free to contact us.

Medical aids do cover rehabilitation. Addiction to alcohol or other drugs is recognised as a treatable illness. Covering treatment costs can prevent long-term health complications. This coverage is based on the widely supported brain disease model of addiction. Alcoholism and drug addiction have been classified as diagnosable diseases for over half a century.

Like other complex health issues, overcoming addiction to alcohol and other drugs involves more than just willpower, intelligence or character strength. Just as with conditions like diabetes or heart disease, recovery requires more than personal resolve, which is why medical aids provide coverage for rehabilitation.

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What do medical aids typically cover?

  • 24 days of inpatient addiction rehabilitation, per year – and
  • 21 days of inpatient psychiatric treatment, per year.

If you have an addiction and a mental health disorder, your medical aid or hospital plan may pay for up to 6 weeks of inpatient treatment per year. Clinics are divided into three specialities:

  • Addiction treatment for adults.
  • Psychiatric care for adults.
  • Treatment for adolescents – whether addiction, psychiatric or behavioural issues. Teenagers are kept separate from adults.

Alcohol and substance use disorder & mental health problems fall under the prescribed minimum benefits (PMBs) of medical schemes. This means your ‘savings’ portion is not affected when you go for inpatient addiction treatment. Often patients have a dual diagnosis: an addiction problem and a mental health issue like depression, anxiety, ADHD or bipolar disorder. This can complicate treatment issues but your medical aid will cover 21 days of inpatient rehab and 21 days of inpatient psychiatric care should you need it.

Co-occurring disorders affect one another. When a mental health problem gets worse, the addiction can get worse too. And vice-versa. These issues are quite common. As reported in the Journal of the American Medical Association:

  • Approximately 50% of people with severe mental disorders also struggle with addiction.
  • 37% of people with AUD and 53% of those with SUD also have at least one serious mental illness.
  • Of all people diagnosed as mentally ill, 29% abuse alcohol or drugs.

Both mental health issues and addiction are likely to get worse if unaddressed. That’s why your medical aid will pay for rehabilitation and psychiatric treatment. The sooner these mental health issues are addressed the better.

We can also get pre-authorisation from medical aids for the treatment of process addictions like eating disorders, gambling & sex addiction from medical aid schemes like Discovery, Fedhealth, Bonitas, Momentum, Medshield and GEMS medical schemes.

With more than 70 years of collective experience in the field, we’ll help you find the best treatment program for you. If you’re looking for a luxury rehab you’ll have to pay a little to top up what your medical aid will not fund.

Be wary of centres that cannot accept medical aid payments. They are likely unregistered and not run by certified professionals.

Ensure that the people treating you are accredited to practice in the addiction field through organisations like the Federation of Drug & Alcohol Professionals, the International Certification & Reciprocity Consortium or are qualified doctors, psychiatrists, psychologists, social workers and occupational therapists in good standing with their relevant boards.

The facility must be fully licensed through organisations like the South African Department of HealthDepartment of Social Development & Board of HealthCare Funders or the UK’s Quality Care Commission.

Usually, PMI (Private Medical Insurance) covers treatment in full so patients choose to stay in the UK close to home & family. If paying privately many UK & Middle East patients travel to Thailand & South Africa to take advantage of the strong GBP currency, reduce costs & ensure anonymity. The current US$ / GBP£ / Euro € exchange rates make luxury rehab attractive to our patients from the Middle East, the UK & Europe, the USA and Canada who aren’t on PMI or would like an exotic rehab experience in a holiday destination. Costs for similar quality treatment in North America or Europe are much higher, so the value for money with treatment abroad is superb.

If you do not have medical aid and cannot afford private treatment, you can contact the South African state facilities or the UK NHS.

South African Medical Aids and Hospital Plans

International Private Health Insurance companies:

Bupa, PPP, Van Breda, Interglobal, Aetna International, Allianz Worldwide Care, Cigna Global Health Benefits, Generali Global Health, IMG Europe Ltd, Pacific Prime, Humana, Allianz, AIA Insurance Group, Aetna Foundation, Blue Cross Blue Shield, Axa, Aviva, United Healthcare, Express Scripts, Zurich Insurance Group, ALC Health, AXA PPP International, Allianz Worldwide Care, BUPA International, ExpaCare, Globality Health, MediCare International and Morgan Price International.

Medical Aids And Addiction Treatment

Medical aid (health insurance) can be incredibly helpful when it comes to paying for rehab in South Africa and indeed anywhere else, for several reasons:

  1. Cost Coverage: Rehabilitation services can be quite expensive, especially for long-term treatment plans. Medical aid can cover all or a significant part of these costs making it financially easier for individuals to access treatment.
  2. Wider Range of Options: Having medical aid could potentially provide access to a broader range of treatment facilities and services, as some premium rehab centers may only accept patients with medical aid.
  3. Continuity of Care: Medical aid can also cover the costs of aftercare services such as ongoing therapy and support groups, which are important for maintaining sobriety and preventing relapse.

However, it’s important to note that not everyone has medical aid and not all medical aids cover addiction treatment. Further to that there might be certain restrictions or limits on the coverage provided.

South African Medical Aids

AECI Medical Aid Society, Alliance Midmed Medical Scheme, Altron Medical Aid Scheme, Anglo Medical Scheme, Anglovaal Group Medical Scheme, Bankmed, Barloworld Medical Scheme, Bestmed Medical Scheme, Bmw Employees Medical Aid Society, Bonitas Medical Fund, BP Medical Aid Society, Building & Construction Industry Medical Aid Fund, Cape Medical Plan, Chartered Accountants (SA) Medical Aid Fund (CAMAF), Community Medical Aid Scheme (COMMED), CompCare Wellness Medical Scheme, De Beers Benefit Society, Discovery Health Medical Scheme, Engen Medical Benefit Fund, Fedhealth Medical Scheme, Fishing Industry Medical Scheme (Fish-Med), Food Workers Medical Benefit Fund, Genesis Medical Scheme, Glencore Medical Scheme, Golden Arrows Employees’ Medical Benefit Fund, Government Employees Medical Scheme (GEMS), Grintek Electronics Medical Aid Scheme, Horizon Medical Scheme, Hosmed Medical Aid Scheme, Impala Medical Plan, Imperial Group Medical Scheme, Keyhealth, LA Health Medical Scheme, Libcare Medical Scheme, Liberty Medical Scheme, Lonmin Medical Scheme, Makoti Medical Scheme, Malcor Medical Scheme, Massmart Health Plan, MBMed Medical Aid Fund, Medihelp, Medimed Medical Scheme, MEDiPOS Medical Scheme, Medshield Medical Scheme, Metrocare, Metropolitan Medical Scheme, Momentum Health, Motohealth Care, Naspers Medical Fund, Nedgroup Medical Aid Scheme, Old Mutual Staff Medical Aid Fund, Parmed Medical Aid Scheme, PG Bison Medical Aid Society, PG Group Medical Scheme, Pick N Pay Medical Scheme, Platinum Health, Profmed, Quantum Medical Aid Society, Rand Water Medical Scheme, Remedi Medical Aid Scheme, Resolution Health Medical Scheme, Retail Medical Scheme, Rhodes University Medical Scheme, SABC Medical Aid Scheme, Samwumed, Sasolmed, Sedmed, Selfmed Medical Scheme, Sisonke Health Medical Scheme, Sizwe Medical Fund, South African Breweries Medical Scheme, South African Police Service Medical Scheme (POLMED), Spectramed, SUREMED Health, TFG Medical Aid Scheme, Thebemed, Tiger Brands Medical Scheme, TopMed Medical Scheme, Transmed Medical Fund, Tsogo Sun Group Medical Scheme, Umvuzo Health Medical Scheme, University Of Kwa-Zulu Natal Medical Scheme, University Of The Witwatersrand – Johannesburg Staff Medical Aid Fund, Witbank Coalfields Medical Aid Scheme, Wooltru Healthcare Fund.

Accredited Rehabs in South Africa

An accredited rehab in South Africa refers to a rehabilitation facility that has been officially recognised and approved by relevant national regulatory bodies. Such accreditation assures patients and their families that the facility provides high-quality care and operates in compliance with specific standards.

Here’s a general outline of what it means to be an accredited rehab in South Africa:

  1. Adherence to Regulatory Standards
    The rehab facility adheres to national and, in some cases, international standards of care and service provision. This includes meeting standards outlined by the South African Department of Social Development and potentially other relevant bodies.
  2. Compliance with Legal Requirements
    The facility operates within the confines of the law, including compliance with zoning regulations, healthcare laws, labor laws, privacy laws and other relevant legislation.
  3. Qualified Staff
    Accredited rehabs employ professionals with the required qualifications in their respective roles, including doctors, therapists, nurses and support staff. These professionals must have the appropriate training, education and experience.
  4. Patient Safety
    These facilities prioritise patient safety, providing a clean, secure environment that encourages recovery. This includes taking appropriate measures to prevent accidents, spread of diseases and ensure overall patient wellbeing.
  5. Program Quality
    Accredited rehabs provide evidence-based treatment programs. These programs should be comprehensive, addressing the physical, mental and emotional aspects of addiction. They also need to be adaptable to the individual needs of each patient.
  6. Ethics
    Accredited rehab facilities uphold high ethical standards in their operations. This includes patient confidentiality, informed consent, respect for patient rights, non-discriminatory practices and professional conduct.
  7. Accountability
    These facilities are accountable to the regulatory bodies and must regularly report their operations, treatment outcomes and any changes to their programs or staff.
  8. Continuous Improvement
    Accredited rehabs are committed to continuous improvement, regularly reviewing and updating their policies, procedures and programs to ensure they are providing the best possible care. They are open to periodic reviews and audits from accrediting organizations.
  9. Treatment Accessibility
    The facility should provide accessible services, either through their own resources or through collaborations with other organizations. This includes provisions for individuals with disabilities or those from different cultural backgrounds.
  10. Financial Responsibility
    Accredited rehab facilities must also demonstrate responsible financial management. This includes transparency in billing and provision of services, fair pricing and adherence to proper financial accounting standards.

 

 

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