Does LA Health Medical Aid Cover Drug And Alcohol Rehab?
LA Health Medical Aid provides coverage for 21 days of inpatient rehab, including a 3-day medically supervised detoxification.
LA Health Medical Aid covers 21 days of inpatient treatment, including a 3-day supervised medical detoxification. This coverage is provided by all plans, regardless of their comprehensiveness, but keep in mind that all plans have exclusions, limitations, and benefit caps.
It’s important to understand that LA Health is not just willing but legally obligated to cover addiction treatment as it falls under the premium-prescribed benefits (PMBs). This means you are covered under any chosen plan, providing a solid sense of security and peace of mind.
Navigating the world of medical aids, their benefits, limitations, and exclusions can be laborious. Here at We Do Recover, we have narrowed down the vital information regarding LA Health Medical Aid so that you don’t have to.
Substance Misuse Rehabilitation Benefits
LA Health Medical Aid provides extensive coverage for various aspects of substance abuse treatment, focusing on providing these coverage benefits at designated service providers (DSPs). Members can be confident they will receive coverage for inpatient treatment programs and specific outpatient program services.
Extent Of Coverage
LA Health Medical Aid ensures members get the treatment they require at one of their designated service providers. When a member is admitted into an inpatient treatment facility, they are covered for 21 days of inpatient treatment, including a 3-day medically supervised detoxification.
It is important to note that most of the costs at these inpatient treatment facilities are covered; however, a co-payment may be required upon admission.
Inpatient vs Outpatient Services
Inpatient treatment involves residing in a facility for an extended period, usually 21 days, which LA Health covers with the possibility of a co-payment. This environment offers a safe and structured space where members can receive intensive treatment for their substance use disorders. Treatments at primary care facilities that can be claimed back from LA Health include:
- Group Therapy Sessions
- Individual Counselling
At We Do Recover, our multidisciplinary clinical team implements an integrated approach when treating our clients, guaranteeing they get the highest level of care to ensure long-term recovery.
The outpatient program takes place during the evening for a set amount of hours during the working week. Individuals who partake in the program have more flexibility to attend to daily responsibilities while still receiving treatment for their addiction.
Outpatient services are usually recommended to individuals who have less severe substance use disorders or as a follow-up treatment after completing treatment in an inpatient rehab facility.
Listed below are the services and programs offered at an outpatient program:
- Group Therapy Sessions
- Individual Counselling
- Lectures On Recovery Related Tasks
- Mini Groups
Members should know that LA Health Medical Aid covers only specific services, not the complete outpatient treatment program.
Eligibility And Claims Process
Understanding if you qualify for coverage and what the claims processes are is crucial. Making an informed decision about your addiction treatment is an investment in yourself and for the rest of your life.
The subsections below will expand on the eligibility criteria for coverage, as well as the claims process.
Qualifying Conditions For Coverage
LA Health Medical Aid has a list of registered designated service providers (DSPs) from which members must choose should they seek the full extent of their benefits. If a member selects a facility not on the DSP list, they will be liable to pay a larger co-payment.
A pre-authorisation process is required before being admitted into an inpatient treatment facility; if the authorisation has not been approved, coverage will not be extended.
Claims Submissions Procedure
To submit a claim to LA Health Medical Aid, you’ll need to provide supporting documentation such as invoices, receipts, and any other relevant information. You can find the claim form on the LA Health Medical Aid website.
Limitations And Exclusions
When considering LA Health Medical Aid for drug rehabilitation, there are a few key factors to consider; all plans are subject to limitations and exclusions, and it is essential to note any shortfalls you may incur.
Coverage limitations
- Duration Of Coverage: How many days LA Health will cover drug rehabilitation treatment is limited.
- Types Of Treatment: LA Health does not cover all addiction therapies. For example, the secondary and tertiary phases of treatment are not covered, and members will be liable to pay out of pocket should they need long-term care.
Treatment Exclusions
- Non-Registered Facilities: Should members receive treatment for their substance use disorders at facilities that are not registered, they will not receive coverage.
- Alternative Therapies: LA Health does not cover therapies that are deemed medically unnecessary or unconventional. Should a member seek treatment using alternative methods, they will not receive coverage.
Pre-Authorisation Process
Members must adhere to a pre-authorisation procedure before being admitted into an inpatient treatment facility.
What Is A Pre-Authorisation Procedure?
A pre-authorisation is a procedure whereby LA Health pre-approves a treatment for coverage; this procedure is implemented to ensure that members are covered for their treatment before admission.
Members can contact us directly at We Do Recover, and we can start the pre-authorisation process on their behalf.
The steps for pre-authorisation are as follows:
- You will provide us with your medical aid details and any other relevant information regarding your substance abuse history.
- We will phone LA Health Medical Aid and provide them with your ICD-10 codes for your specific addiction, including our facility’s practice numbers.
- Finally, you will not need a referral letter from a medical healthcare professional.
Conclusion
LA Health Medical Aid provides extensive drug and alcohol rehabilitation coverage for its members. While plans may have limitations and exclusions and, in some cases, co-payments, members can rest assured that they will be covered for the majority of their 21 days of inpatient treatment care, including a 3-day medical detoxification.
Here at We Do Recover, we have years of experience dealing with pre-authorisations and medical aids. We understand that the process before admission can be stressful, so we are here to guide you every step of the way.
Call us today at 081-444-7000, and we can start the pre-authorisation process for you.
FAQS
Members who are seeking treatment for their substance use disorders will receive coverage for 21 days of inpatient treatment, including a 3-day medical detox. However, members may be subject to a co-payment upon admission. No, LA Health does not cover secondary and tertiary care facilities. Members will be liable to pay out-of-pocket for these phases of treatment. LA Health only covers specific services offered at the outpatient treatment program, not the entire one.What Types of Inpatient Rehabilitation Services Are Included In The Plans From LA Health Medical Aid?
Does LA Health Medical Aid Cover Secondary And Tertiary Rehab Facilities?
Does LA Health Medical Aid Cover The Outpatient Program?