Discovery Medical Aid pays for 21 days of inpatient alcohol and drug rehab as well as 3 days of detox annually. 

Discovery is one of the most popular healthcare providers in South Africa, offering a range of benefits to its members. One key benefit that its members seek is drug and alcohol rehabilitation coverage.  Call us today for immediate help and to check pre-authorisation on 081-444-7000.

You will be relieved to know that Discovery covers inpatient rehabs under all of their plans because South Africa recognises addiction as a PMB (prescribed minimum benefit), acknowledging the importance of treating substance use disorders, covering 21 days of inpatient rehab and 3 days of detox per year.

It is essential to understand the eligibility criteria for inpatient rehab coverage, the extent of coverage, exclusions, limitations, and the pre-authorization process required for admission. 

This article will provide an in-depth overview of Discovery Medical Aid coverage for drug and alcohol rehab and answer frequently asked questions.

Overview Of Discovery Medical Aid Coverage

Discovery Medical Aid Schemes is one of the leading medical aid providers in South Africa. The different plans offer members various benefits to suit their healthcare budgets and needs. One benefit of all plans is coverage for inpatient rehab facilities.

Discovery covers a range of different addiction treatment programs, including inpatient and outpatient care and a medical detox.

It is important to note that Discovery Medical Aid’s coverage may have specific limitations and exclusions. Contact us at We Do Recover, and we can start the pre-authorization process for you.

Understanding Discovery Medical Aid Cover

Starting in 2024, regardless of the Discovery Medical Aid plan you are covered by, Discovery will fund rehabilitation at the same rate. Typically, Discovery pays R1,300 per day spent in treatment, with a co-payment ranging from R20,000 to R30,000, depending on the chosen rehab facility and the length of inpatient treatment.

The rehabilitation benefit is a PMB (prescribed minimum benefit), meaning Discovery is legally obligated to pay for rehab treatment. Discovery offers various plans, including the  Classic Comprehensive, Essential Comprehensive, Essential Delta Comprehensive, and Classic Delta Comprehensive plans, each with distinct coverage levels and benefits.

Eligibility Criteria For Rehab Coverage

Discovery Medical Aid provides coverage for substance use disorders and drug rehabilitation at one of their designated service providers (DSPs) for a maximum of 24 days per year, which includes a 3-day detox, depending on what plan the member is on.

However, specific criteria must be met before coverage can be granted. To be eligible for rehab coverage, the beneficiary must be a member of Discovery Medical Aid and meet specific criteria (clinical assessment) for coverage. Many plans offer varying benefits; the higher the plan, the more extensive the coverage.

Clinical Assessment Requirement

A clinical assessment must be done to determine the member’s eligibility for drug and alcohol rehab before the coverage is granted. The evaluation is done by the specific alcohol and drug rehab that the member chooses and is based on the patient’s medical history, physical examination, and other relevant factors.

A DSP designated by Discovery can also perform the clinical assessment. If the beneficiary decides to go to an unlicensed rehab, coverage will not be granted.

Extent Of Coverage For Drug And Alcohol Rehab

Discovery Medical Aid provides coverage for drug and alcohol rehabilitation. However, the extent of coverage depends on your specific plan. The plans with the most extensive coverage are the Classic Comprehensive and the Essential Comprehensive, which cover inpatient care, specific outpatient therapies, medication, and therapy sessions.

Inpatient Rehab Treatment

Discovery medical aid covers 24 days of inpatient rehab per year, from January to January; this includes accommodation, meals, and individual and group therapy sessions.

The inpatient treatment services are provided by designated service providers who are licensed to provide these services. The treatment program includes a medically supervised detoxification process.

Outpatient Rehab Treatment

Outpatient Treatment services may be covered depending on the you are on. The Classic Comprehensive Plan covers group therapy and 15 individual psychology therapy sessions, which can be used during the outpatient program.

Exclusions And Limitations

While Discovery offers rehabilitation coverage, there are certain limitations and exclusions to be aware of; these exclusions ensure that the medical aid plan is used for medically necessary treatments and to avoid abuse of the system.

Non-Covered Treatments

Discovery will not cover treatments that are not considered medically necessary. This means that if a patient seeks treatment that is not deemed medically necessary, Discovery Medical Aid will not grant coverage. 

Benefit Caps And Co-Payments

Discovery Medical Aid pays for up to 24 days of inpatient rehab, including a medically supervised detoxification. It is important to be aware that members are limited by benefit caps.

Additionally, depending on their plan, members may be required to pay co-payments upon admission for specific treatments. Members must carefully review their plans to fully understand their coverage, benefits, and whether a co-payment will be required. 

Alternatively, individuals can consult with a professional from WeDoRecover to understand what is covered and what is not.

How To Pay For Rehab Without Discovery Medical Aid

If you’re not on Discovery Medical Aid, or they don’t cover all of your expenses, it is important not to let that stop you from getting treatment for your substance use disorder. There are different avenues to explore when looking for ways to pay for treatment. 

Listed below are some of the ways you can pay for the shortfalls:

• Payment Plans: Depending on your chosen rehab facility, you can negotiate a payment plan. 
• Affordable Medical Aid Plans: Research and find the most affordable medical aid plan that will cover all your necessary expenses.
• Take Out A Loan: Consider requesting a loan from your bank. 

Will Discovery Pay For An Out-Of-Network Rehab Facility?

The short answer is no. Members will need to seek in-network treatment to receive coverage and full benefits. Additionally, even if a member chooses an in-network facility, they may still be liable to pay for shortfalls and co-payments, depending on their plan.

If members choose an out-of-network facility, they may be liable to pay for all the inpatient rehab treatment costs.

Additional Resources 

Aside from coverage for rehab, Discovery Medical Aid also provides additional resources for those who are struggling with substance use disorders. These resources include a 24/7 emergency helpline: 0860-999-911, access to a network of specialists, and online support groups. 

These resources are incredibly beneficial for individuals who are struggling with addiction and can further aid in sustaining long-term recovery.

Conclusion

Discovery Medical Aid is popular in South Africa because it offers various appealing benefits and plans to suit individuals’ budgets and needs. 

Members need to consult with a reputable South African rehab centre or Discovery to become knowledgeable on what extent of coverage and benefits they will receive; this makes the process of being admitted into a rehab facility easy and can prevent any hidden costs that may come up that members were unaware of.

At We Do Recover, we can start the pre-authorise rehab process for you; contact us today, and we will put you through to our admissions department, who will consult with you and Discovery over a short phone call. 

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