Treatment is often crucial for those with addiction or mental health issues.
Does Discovery Health pay for rehab? Yes.
Most South African medical aid schemes provide financial support to access evidence-based therapies and treatment programs. This article will explore how medical aid schemes in Johannesburg and across South Africa can help you cover your rehab expenses and set you on the path to a brighter future.
Mostly, it’s the people around us, that care for us, that pressure us to get help. They see the damage more clearly than we can. It’s often just the nudge we need to set us on our recovery journey.
When you do seek help, it’s comforting to know that your medical aid scheme will be there to pay for rehab. Thankfully, most medical aid schemes in South Africa recognize addiction as a PMB (Prescribed Minimum Benefit) acknowledging the importance of quality rehabilitation and cover 21 days of inpatient treatment per year.
Yes, per year. Every year.
Medical aids understand that addiction is a primary, chronic brain disorder and recovery is a long-term process. They only pay accredited, licensed rehabs that provide quality, evidence-based treatment. medical aids know that treatment is vital in helping you achieve and maintain sobriety.
Your medical aid plan can help you access a range of evidence-based therapies, including the 12-step philosophy. This approach is an internationally recognized, time-tested method for overcoming addiction. Rooted in the principles of Alcoholics Anonymous, the 12-step philosophy encourages personal growth, self-awareness, and accountability as you work through each step with the support of a community. Many rehab centres in Johannesburg and across South Africa incorporate the 12-step philosophy into their treatment programs, allowing you to benefit from this proven approach. Engaging in a 12-step programme is a great way to give and receive long-term support.
In addition to the 12-step philosophy, your medical aid scheme can also cover other evidence-based therapies that have been proven to be effective in treating addiction. Therapies like cognitive-behavioural therapy (CBT), motivational interviewing, and family therapy – all look at clearing away the chaos of the past, addressing underlying issues and how you can move forward. By covering these evidence-based therapies, your medical aid ensures that you receive the most effective care possible during your time in rehab.
You do not need a GP or other health professional referral to go to rehab. Any quality rehab will take your details and call the medical aid to pre-authorise on your behalf. The clinic will provide the specific ICD-10 codes for alcoholism or addiction and getting the pre-auth is easy.
Medical aids cover 21 days of inpatient treatment for AUD & SUD per year (Substance Use Disorder and Alcohol Use Disorder). If you’re new on the medical aid there may be a predetermined waiting period before benefits are accessible.
There is usually a co-payment amount as medical aids cover at a certain daily rate that will not cover the full treatment costs at the best rehab centres. This co-payment amount will be discussed once your medical aid has released the exact amount it’ll cover for your treatment.
| Benefits of Medical Aid Paying for Rehab | Without Medical Aid Paying |
| Quick access to evidence-based therapies and a tailor-made treatment plan | Limited treatment options due to financial constraints |
| Full-time inpatient programme: GP, detox, psychologists, psychiatry, nursing, group and individual therapy and lectures | Out-of-pocket expenses for inpatient or outpatient treatment |
| Financial support for inpatient and outpatient programs | Struggling to afford necessary treatment programs |
| Reduced financial burden | Potential debt for rehab expenses |
| Opportunity to focus on healing and personal growth | Stress about treatment costs hindering recovery progress |
| Access to professional, individualised help and guidance | Difficulty finding appropriate support and resources |
| Reinforcement to seek addiction treatment sooner | Delay in seeking help due to cost concerns |
| Potential coverage for aftercare services | Access to aftercare services and dependent on finances |
| Possible longer treatment adding too recovery commitment | Higher risk of relapse due to inadequate treatment |
| Improved chances of long-term success and lasting recovery | Lower chances of long-term success and lasting recovery |
Research rehab facilities in Johannesburg or elsewhere in South Africa that offer evidence-based therapies and programs, such as the 12-step philosophy, cognitive-behavioural therapy, and other proven treatments. Make a list of potential rehab centres that align with your needs and preferences. Call and speak to each facility and get a sense of how they do, what they do.
Confirm whether they accept your medical aid scheme. This will help you narrow down your options to facilities that are compatible with your coverage.
After receiving approval from your medical aid provider, communicate with your chosen rehab facility to coordinate your admission. Discuss any additional paperwork, assessments, or preparations needed before starting your treatment.
Get admitted to your chosen rehab program as scheduled, whether it’s an inpatient or outpatient program. Engage fully in the evidence-based therapies and treatments offered to make the most of your time in rehab and maximize your chances of a successful recovery.
If there are any issues with your medical aid provider during your treatment, the rehab centre will communicate this to you. It’s rare to have issues once the medical aid has pre-authorised. There is usually a co-payment that will need to be made. Medical aids pay out at a certain daily rate and the better rehabs will charge more than this. Talk with your chosen rehab and they’ll explain how much the co-payment is.
Follow through with aftercare. Once you’ve completed your rehab program, continue to follow any aftercare recommendations provided by your treatment team. This may include attending support group meetings, continuing therapy, or participating in ongoing recovery programs. Your medical aid scheme may also cover some of these aftercare services, so be sure to check with the rehab and your provider as needed.
Moving from mental health and addiction issues towards recovery can seem like an overwhelming task. With your medical aid giving you the opportunity to access essential care, it’s easier.
By covering rehab expenses, medical aid not only eases your financial burden but also allows you to focus on what truly matters – your healing and personal growth.
As you delve into your addiction and work to address the underlying issues, you need the guidance of skilled professionals. Counselling sessions, whether one-on-one or in a group setting are a core part of evidence-based therapies. These activities promote lasting recovery. Please fully engage in the therapeutic process to reap the full benefits of expert advice and treatment.
Treatment is designed to help you deal effectively with your past, gain insight into what makes you tick and build healthy coping strategies for the future. Improve communication and mended relationships are important on your recovery journey.
Your medical aid could be the lifeline you need for a better future. By investing in your treatment you’re acknowledging your worth and value.
By investing in your recovery through medical aid, you acknowledge your worth and set the stage for a brighter, healthier life.
FAQs
We understand that you may have questions about how medical aid can support your path to recovery. Here are five frequently asked questions that address concerns specific to South African audiences:
1. Will my medical aid scheme cover the full cost of rehab?
Coverage varies among different medical aid schemes and plans. You can contact your broker, review your scheme or call us and we can pre-authorise on your behalf. If we call us to pre-auth on 081-444-7000, it’ll give us all the info and it’s really quick.
2. How do I find a rehab facility that accepts my medical aid scheme?
Rehab centres accredited by the DSD (Dept. of Social Development) and the DOH (Dept. of Health), as well as the BHF (Board of Healthcare Funders), can claim from various medical aid schemes in South Africa. Be aware that rehabilitation centres that cannot claim from your medical aid are likely to be unlicensed.
3. Is inpatient or outpatient rehab covered by my medical aid scheme?
Both inpatient and outpatient rehab programs may be covered, depending on your specific medical aid plan. Usually, your medical aid will cover 21 days of inpatient rehabilitation each year, for every family member on the policy. The comprehensive plans will cover 15 outpatient sessions with a psychologist too. Comprehensive medical aid plans may also cover other HPCSA registered addiction professionals.
4. Can I access rehab services even if I have a pre-existing condition?
Many medical aid schemes in South Africa do cover rehab services for pre-existing conditions, but this coverage may be subject to waiting periods or other restrictions.
5. What is the process for getting approval for rehab from my medical aid scheme?
The process may vary among different schemes. Any quality rehab that medical aids pay for will be able to take your details and get pre-authorisation very quickly. There’s no need for a referral from a healthcare professional like a GP, psychologist or psychiatrist. The rehab will provide your details along with the ICD-10 codes and clinic practice numbers for quick pre-auth. and approval.
Top Tips for Choosing a Rehab
Research rehab facilities in Johannesburg or elsewhere in South Africa that offer evidence-based therapies and programs, such as the 12-step philosophy, cognitive-behavioural therapy, and other proven treatments. Make a list of potential rehab centres that align with your needs and preferences. Call and speak to each facility and get a sense of how they do, what they do.
Confirm whether they accept your medical aid scheme. This will help you narrow down your options to facilities that are compatible with your coverage.
After receiving approval from your medical aid provider, communicate with your chosen rehab facility to coordinate your admission. Discuss any additional paperwork, assessments, or preparations needed before starting your treatment.
Get admitted to your chosen rehab program as scheduled, whether it’s an inpatient or outpatient program. Engage fully in the evidence-based therapies and treatments offered to make the most of your time in rehab and maximize your chances of a successful recovery.
If there are any issues with your medical aid provider during your treatment, the rehab centre will communicate this to you. It’s rare to have issues once the medical aid has pre-authorised. There is usually a co-payment that will need to be made. Medical aids pay out at a certain daily rate and the better rehabs will charge more than this. Talk with your chosen rehab and they’ll explain how much the co-payment is.
Follow through with aftercare. Once you’ve completed your rehab program, continue to follow any aftercare recommendations provided by your treatment team. This may include attending support group meetings, continuing therapy, or participating in ongoing recovery programs. Your medical aid scheme may also cover some of these aftercare services, so be sure to check with the rehab and your provider as needed.
Moving from mental health and addiction issues towards recovery can seem like an overwhelming task. With your medical aid giving you the opportunity to access essential care, it’s easier.
By covering rehab expenses, medical aid not only eases your financial burden but also allows you to focus on what truly matters – your healing and personal growth.
Medical aid and Hospital Plan patients are usually covered for 21 days to 24 days of inpatient addiction treatment per year. In some instances, patients are responsible for a co-payment to cover the shortfall between what their medical aid covers and our costs.
For patients who are on a medical aid or hospital plan, the majority of their treatment costs are covered. Depending on your medical aid scheme and the package you’re on, these costs include medication, clinical costs, residential costs and fees related to consultations with health professionals which include doctors, psychiatrists, psychologists, registered counsellors, occupational therapists and social workers.
For patients not part of a medical scheme or those who have utilised their annual benefits, a private rate is available. We also have a number of subsidised beds available for those who can’t pay the full fee’s. Please contact us to discuss on 081-444-7000.
Changes Addiction Rehab is approved and licensed by the DSD (Department of Social Development), the DOH (Department of Health) and the BHF (Board of Healthcare Funders)
Countless Benefits of Quality Treatment
As you delve into your addiction and work to address the underlying issues, you need the guidance of skilled professionals. Counselling sessions, whether one-on-one or in a group setting are a core part of evidence-based therapies. These activities promote lasting recovery. Please fully engage in the therapeutic process to reap the full benefits of expert advice and treatment.
Treatment is designed to help you deal effectively with your past, gain insight into what makes you tick and build healthy coping strategies for the future. Improve communication and mended relationships are important on your recovery journey.
Does my medical aid pay for rehab? It should! Your medical aid could be the lifeline you need for a better future. By investing in your treatment you’re acknowledging your worth and value.
By investing in your recovery through medical aid, you acknowledge your worth and set the stage for a brighter, healthier life.
Contact us now. We’d love to be part of you and your family’s healing. Together, we’ll pave the way for a lasting recovery.
As the famous quote by Rumi goes, “The wound is the place where the light enters you.” Embrace the support of medical aid to cover your rehab expenses, and let the light of recovery illuminate your path to a brighter, healthier life.