Does Fedhealth Medical Aid Pay For Addiction Rehab?

Fedhealth Medical Aid is a reputable South African Medical Aid scheme that offers its members a variety of plans and benefits, including coverage for 21 days of inpatient rehab treatment and a 3-day medically supervised detoxification.

Members who are struggling with a substance use disorder can receive financial support for their treatment, which includes residential inpatient treatment and outpatient rehabilitation services.

Fedhealth Medical Aid’s extensive benefits are tailored to deliver maximum value to its members. This commitment is evident in its coverage of crucial aspects of addiction treatment, such as inpatient treatment, a pivotal step toward long-term recovery. Additionally, the scheme may cover outpatient and medication treatment services, further enhancing its comprehensive support.

If you are a Fedhealth member and find yourself struggling with addiction, it is essential to understand your eligibility for coverage, the scope of coverage, and any limitations and exclusions you may be subjected to. By understanding these key factors, you will enable yourself to make an informed decision about your treatment options and get the support that you need.

At We Do Recover, we will guide you along the pre-authorisation process, making admission into our facility as smooth as possible.

Eligibility For Drug And Alcohol Treatment Coverage By Fedhealth

Fedhealth offers drug and alcohol treatment coverage to its members. However, members must meet specific criteria to be covered at addiction treatment facilities.

Membership Status Criteria

Members need an active Fedhealth Medical Aid Membership to be covered by Fedhealth for treating substance use disorders. This means that members must have paid their premiums and not lapsed on a payment. 

Members who lapsed on a payment may only qualify for coverage once their membership is reinstated.

Medical Necessity Criteria

To qualify for coverage from Fedhealth for substance use disorders, members must meet specific medical criteria.

Medical necessity criteria may differ depending on the level of treatment being sought. For example, a member seeking inpatient treatment must meet certain criteria that differ from those for outpatient treatment. It is important to be aware that only specific services in outpatient treatment may be covered, not the program as a whole. 

At We Do Recover, we will assess the severity of your substance use disorder and determine what phase of treatment would best suit your needs. In some cases, inpatient treatment is not necessary, and outpatient treatment can be recommended.

Scope Of Coverage For Substance Abuse Treatment 

Fedhealth Medical Aid provides substance abuse treatment coverage to its members. However, the scope of coverage may vary depending on the specific plan chosen by the member.

Luckily, all the plans offered by Fedhealth include a minimum set of benefits that cover in-hospital treatment and chronic condition treatment, including addiction treatment.

Inpatient Treatment Facilities

Fedhealth Medical Aid plans include inpatient addiction treatment services, which involve residing at a residential inpatient facility for an extended period. Fedhealth covers 21 days of inpatient treatment and a 3-day medical detoxification.

Inpatient rehabilitation services may include medical detoxes, individual counselling sessions, group therapy, and certain medications. 

Outpatient Treatment Services

Fedhealth Medical Aid may also cover outpatient treatment services. Outpatient programs typically involve individual counselling, group therapy, and other forms of treatment that can be claimed under Fedhealth.

Therapy And Counselling

Therapy and counselling services are the cornerstones of rehab treatment practices. Fedhealth Medical Aid plans may cover therapy and counselling services for substance use disorders. These services may be provided by licensed therapists, psychologists, social workers, and medical doctors.

Individual counselling and group therapy sessions can equip individuals with the necessary tools to combat addictive patterns of behaviour and develop healthy coping mechanisms that aid in sustaining long-term recovery.

Limitations And Exclusions

Fedhealth Medical Aid Members may be subjected to benefit caps, limitations, and exclusions. 

Non-Covered Services

Although Fedhealth covers treatment for substance use disorders, there are some treatments and procedures that are not covered. These include:

• Treatment for process addictions such as gambling, porn, and love addiction.
• Treatment for an addiction that is not by a registered healthcare professional.
• Treatment for an addiction that is not provided by a registered treatment centre.
• Treatment for an addiction that was not pre-authorised by Fedhealth Medical Aid.

Additionally, members must be aware that Fedhealth will not cover services that are not deemed medically necessary; this means that coverage will not be granted if treatment is not required to treat the addiction.

Treatment Duration Limitations

Fedhealth Medical Aid has limits on the duration of addiction treatment coverage. The duration of coverage is determined by the benefits accompanying the member’s chosen plan. 

If a member exceeds the duration of coverage for addiction treatment, they will be liable to pay for any additional treatment services out-of-pocket.

In addition, members may be liable to a co-payment before admission. You can contact us at We Do Recover to start the pre-authorisation process, and we can help answer any of your questions regarding your admissions process.

Claims and Reimbursements

Submitting Claims

Fedhealth Medical Aid offers several ways for members to submit drug rehabilitation claims. Members can submit their claims online through the Fedhealth app or by emailing them directly. To submit a claim, members must provide their medical aid number, personal details, and any relevant supporting documents, such as receipts and invoices.

Claim Assessment

Once Fedhealth Medical Aid receives the claim, it will be reviewed. This assessment will determine whether or not the claim is eligible for reimbursement. The assessment process includes verifying the member’s eligibility for the treatment of their substance use disorder, reviewing the treatment plan, and checking that registered healthcare professionals and treatment facilities provided the treatment.

If the claim has been approved, Fedhealth Medical Aid will reimburse the member for eligible expenses.

Conclusion

Fedhealth Medical Aid members must have an active membership to be eligible for drug and alcohol rehab treatment coverage.

Through thoroughly reviewing your plan, you can make a well-informed decision about your substance dependency and avoid any surprise costs.

Fedhealth is committed to ensuring its members receive high-quality, appropriate treatment care and works with numerous accredited drug rehabilitation facilities to fulfil this commitment. 

Contact us at We Do Recover for more information regarding your Fedhealth Medical Aid Scheme, and start your pre-authorisation process today. We are here to guide you every step of the way.

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