Medihelp Medical Aid Scheme pays for 21 days of inpatient rehab, including a 3-day medically supervised detoxification. Treatment for substance use disorders falls under the premium prescribed benefits (PMBs); this means that no matter what plan a member is on, Medihelp Medical Aid is legally obligated to cover a large portion of their addiction treatment program.

When dealing with substance use disorders, navigating the waters of medical aids is crucial. Understanding your benefits, exclusions, and limitations will help you decide when choosing an inpatient treatment facility and addiction treatment program that best suits you so that you may maximise your benefits. 

At We Do Recover, we understand that the process of admissions and pre-authorisation can become a bit tedious and overwhelming. This article will explain everything Medihelp Medical Aid members need to know about their benefits regarding alcohol and drug abuse treatment benefits and exclusions.

Eligibility Criteria For Drug And Alcohol Rehab Coverage

Members of Medihelp Medical Aid must use accredited inpatient rehab facilities to receive coverage for their drug and alcohol rehab treatment; this ensures their members will receive quality treatment for their substance use disorders. 

Pre-authorisation will be required before admission into an inpatient treatment facility. Members who choose a facility that is not on the designated provider’s list will be liable to pay more for their treatment plan.

Call us today at We Do Recover, and we will begin the pre-authorisation process for you on your behalf.

Extent Of Coverage For Substance Use Disorders 

Medihelp Medical Aid covers a wide range of addiction treatment therapies; these include residential inpatient treatment, outpatient services, individual and group therapy sessions and a medically supervised detoxification.

The plans offered by Medihelp Medical Aid differ in the scope of coverage and exclusions, so members must carefully review their plans to better understand the extent of their coverage. The rule of thumb is that the more comprehensive the plan, the more extensive the coverage.

Types Of Addiction Treatment Covered By Medihelp Medical Aid

Medihelp Medical Aid understands the severity of substance use disorders, which is why comprehensive coverage is offered to its members. 

Listed below are the addiction treatments members can expect to be covered by Medihelp, subject to their plan’s terms and conditions:

• Residential Inpatient Treatment: Medihelp Medical Aid covers 21 days of inpatient rehab, including a medically supervised detoxification. If a member does not complete their stay at an inpatient facility, they will be liable to pay the remaining balance upon discharge.
• OutpatientPrograms: Outpatient Treatment Services are included in addiction treatment plans. However, Medihelp Medical Aid does not cover the entire program.
• Group Therapy: Group Therapy sessions are included in the coverage of addiction therapies; this therapeutic approach involves multiple individuals sharing and relating while being facilitated by a counsellor.
• Individual Counselling: Members will receive specialised care and tailored programs to suit their needs.
• Medical Detoxification: Members are covered for a 3-day medically supervised detoxification.

Below is a table that shows the types of addiction treatments and their extent of coverage by Medihelp Medical Aid:

Claims Procedure For Medihelp Medical Aid

Gathering supporting documentation, invoices, and other relevant information is essential for navigating Medihelp Medical Aid’s claims process.

Ensuring that all the supporting documentation has been adequately reviewed will guarantee a quick and easy claims process.

Required Supporting Documentation

If members want to claim for the treatment of their substance use disorders, they will need to provide all supporting documentation. These include the medical aid membership card, detailed medical reports from healthcare professionals and invoices from the inpatient rehab facility.

The invoices must be accurate and reflect the treatment duration and the therapies received. Medihelp Medical Aid will also require proof of payment, so members must keep all their receipts.

Approval Process For Addiction Treatment Coverage

Once the claim has been submitted, Medihelp Medical will review it. If it meets all the coverage requirements, it will be approved.

Medihelp Medical Aid will disburse payments directly to the treatment facility or the member’s bank account upon approval. If a co-payment is required before being admitted, it will be specified, and the member must cover the remaining costs out-of-pocket.

At We Do Recover, we know that the claims and admissions process can be time-consuming. Please call us today at 081-444-7000, and we will guide you through the process every step of the way.

Limitations And Exclusions

Members benefit from Medihelp Medical Aid by receiving comprehensive coverage for their addiction. However, even the most comprehensive plans are subject to limitations and exclusions.

Exclusions

• Behavioural addictions such as gambling and porn addictions. If members want to receive treatment for these issues, they will need to be admitted into a psychiatric care facility.
• Medihelp Medical Aid does not cover secondary and tertiary treatment facilities and will be required to be financed privately.

Limitations

• Members are limited to 21 days of inpatient treatment, including medical detoxification.
• Members are limited to a certain number of therapy sessions they can claim per year.

Conclusion

Medihelp Medical Aid understands the severity of substance use disorders and provides comprehensive coverage, ensuring its members get the quality treatment they require. It is essential that members carefully review their plans to understand the extent of their coverage fully. 

Making an informed decision about your addiction treatment facility is not only important, it’s empowering. Admitting that there is a problem takes courage and the willingness to seek help even more so.

At We Do Recover, we want our clients to have a stress-free admissions process. Call us today at 081-444-7000, and we can start the pre-authorisation process on your behalf.

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