Multi-Choice Medical Aid Scheme, a trusted and reliable medical aid provider in South Africa, understands the significance of addressing substance use disorders. They provide coverage for 21 days of inpatient treatment, which includes a 3-day medically supervised medical detoxification.

Multi-Choice Medical Aid has various plans to suit its members’ budgets and needs. Luckily, they are obligated to cover addiction treatment as it falls under the prescribed minimum benefits (PMBs). This means that every hospital plan includes coverage for alcohol and drug misuse treatment.

Deciding to admit yourself into a treatment centre to treat your substance use disorder is no easy feat, but it takes tremendous courage to admit you have a problem. At We Do Recover, we understand that navigating the admissions and pre-authorisation process with Medical Aids can be tedious, which is why we are here to help. 

This informative article will discuss everything you need to know about the plans Multi-Choice Medical Aid offers, including their pre-authorisation and claims process. 

Role Of Medical Aid In Substance Abuse Treatment

Medical Aid Schemes play a massive role in the access to addiction treatment services. All schemes are legally obligated to cover substance abuse rehabs under the premium prescribed benefits (PMBs). This coverage includes residential treatment facilities, outpatient program services, counselling therapies and medical detox programs.

Members may face co-payments upon admission into an inpatient treatment facility as medical aids might not always cover the total cost of the facility. 

Pre-authorisation procedures must also be adhered to before admission into a primary care substance abuse rehab. Adherence to these procedures will ensure that coverage is not denied.

Substance Abuse Treatments Covered By Multi-Choice Medical Aid

The treatment of substance use disorders involves treating individuals with tailored programs to suit their specific needs. Medical Aid plays a vital role in access to treatment for addiction therapies.

Inpatient Treatment

Inpatient rehabilitation treatment involves residing in a facility for an extended period. Staying at an inpatient facility allows individuals to receive intensive treatment for their addiction in a highly structured and safe environment. 

Multi-Choice Medical Aid covers 21 days of inpatient treatment; however, members may be liable to a co-payment upon admission.

Outpatient Program Services

The outpatient program is for individuals who must attend to daily responsibilities and cannot commit to inpatient treatment. It runs for two hours in the evening, five days a week. 

It is crucial to understand that the outpatient program is for individuals whose substance use disorder is not severe. Usually, the program is a transitionary phase of treatment after inpatient.

Lastly, Multi-Choice Medical Aid only covers part of the program. Members can claim for specific addiction therapies, such as individual counselling.

Medical Detoxification

Multi-Choice Medical Aid covers a 3-day medically supervised detox once per year.

Counselling And Therapy

Multi-Choice Medical Aid covers counselling and therapy sessions, including individual, group, and family sessions. However, there are benefits caps, and members should revise their plans to determine their session limit.

Claims Process For Substance Abuse Treatment

Submitting a claim for substance abuse treatment through Multi-Choice Medical Aid involves steps that must be adhered to for it to be approved and for funds to be reimbursed. These steps include getting a pre-authorisation for the chosen facility, gathering all the necessary documentation and submitting a well-supported claim.

Multi-Choice Medical Aid requires all supporting documentation to be submitted with their claim forms. Members can submit their forms through their online customer portals.

Limitations And Exclusions

The plans offered by Multi-Choice Medical Aid are subject to limitations and exclusions. 

The following subsections below will discuss in detail what they are.

Covered vs Uncovered Addiction Treatments

Multi-Choice Medical Aid covers inpatient treatment and detox but does not cover secondary or tertiary phases of treatment.

Exclusions

Treatments that won’t receive coverage by Multi-Choice Medical Aid include:

• Alternative forms of therapy
• Medication that was not prescribed by a medical health professional

Co-Payments 

Sometimes, members may be liable to co-pay upon admission into an inpatient treatment facility.

Members of Multi-Choice Medical Aid can contact us at We Do Recover to determine if they require a co-payment upon admission.

Pre-Authorisation Procedure For Admission into A Primary Care Substance Abuse Facility

To be admitted into a residential rehab facility, a quick and straightforward process must be followed. 

Members of Multi-Choice Medical Aid can contact us at We Do Recover, and we can start the pre-authorisation process on your behalf. The process looks like this:

• We will need to obtain your medical aid details.
• We will contact Multi-Choice Medical Aid on your behalf and provide them with our facilities’ practice numbers and ICD-10 codes for your specific addiction.

Conclusion

Multi-Choice Medical Aid provides comprehensive substance abuse treatment to its members with multiple plans to suit their individual needs and budgets. 

Addiction is a chronic brain disease and, if left untreated, can have fatal consequences. The premium prescribed benefits allow members to receive treatment for their addiction to drugs and alcohol no matter what plan they are on. 

At We Do Recover, we aim to alleviate unnecessary stress for our clients during admissions. Call us today at 081-444-7000, and we will start the pre-authorisation procedure on your behalf.

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