Remedi Medical Aid provides coverage for 21 days of residential inpatient rehab treatment, including a 3-day medically supervised detox per year. Remedi offers various plans, including the Comprehensive, Classic, and Standard, to suit its members’ budgets and needs. 

Struggling with a substance use disorder is not something that you have to battle alone. If you are a member of Remedi Medical Aid, you will be relieved to know that you will be covered, as addiction treatment falls under the Premium Prescribed Benefits (PMB). These benefits are there to ensure individuals who are on medical aid schemes receive vital care and support for substance use disorders. 

At We Do Recover, we understand that navigating medical aid plans, their benefits, limitations and exclusions can be overwhelming. For members of Remedi Medical Aid, we have put together a simple article explaining everything you need to know about the basics of your medical aid plan.

Coverage Overview For Drug And Alcohol Rehabilitation

Remedi Medical Aid provides extensive coverage for substance abuse treatment to its members. Listed below is an overview of what their members can expect:

Designated Service Providers (DSPs): 

Remedi Medical Aid has a list of designated service providers that members must use to receive their maximum benefits. If a member chooses a rehab facility not on their DSP list, they will be liable to pay extra for their treatment.

Inpatient Rehab Treatment:

Members will receive coverage for 21 days of inpatient rehab treatment, including a 3-day medically supervised detox per year. 

Outpatient Program Services:

Remedi Medical Aid covers outpatient treatment services plans; however, the extent of coverage will depend on the type of plan the member is enrolled on. Members can claim individual counselling sessions during the outpatient program.

Therapy And Counselling:

Therapy and counselling services are vital in the treatment of substance use disorders and co-occurring mental health issues. Comprehensive plans offer the most extensive coverage for counselling benefits.

Pre-Authorisation Process For Drug And Alcohol Rehab Coverage

Remedi Medical Aid provides coverage for the treatment of substance use disorders to its members on condition they adhere to the pre-authorisation process and approval has been granted. 

Here are the steps required to be admitted into an inpatient rehabilitation facility:

1. Members can contact us at We Do Recover, and we can begin the pre-authorisation process on their behalf. We will provide Remedi Medical Aid with your ICD-10 codes and our facilities’ practice numbers.
2. A referral letter from a healthcare professional is not required to be admitted into an inpatient rehab facility.

The timely process of pre-authorisation helps avoid delays in getting care. Failure to adhere to pre-authorisation protocols can result in claims being rejected. When a claim is rejected, the member will be liable to pay out-of-pocket. Members must get pre-approval to avoid these situations.

Rehabilitation Services Covered 

Members of Remedi receive a substantial amount of coverage for the treatment of their substance use disorders.

Below are the services covered and an overview of what to expect:

Inpatient Rehab Treatment Services

Inpatient services through Remedi Medical Aid cover a significant portion of the treatment costs. Patients are admitted into a residential inpatient treatment facility for 21 days, where they will receive quality care, including psychotherapy from registered mental healthcare professionals, medically supervised detoxification, and other necessary treatments. Most members must co-pay for their inpatient treatment upon admission, as medical aid typically doesn’t pay 100% of the costs. 

The purpose of inpatient treatment is for individuals to gain insight into the maladaptive behaviours associated with their substance use disorders and to acquire valuable coping mechanisms to sustain long-term recovery.

Outpatient Services

Members of Remedi Medical Aid are also supported for certain outpatient services. The Outpatient Treatment Program is ideal for individuals who need to attend work, school and other immediate responsibilities while still receiving an adequate level of treatment for their substance use disorder.

The Outpatient Treatment Program meets for two hours in the evening, five days a week. Members receive individual counselling, group therapy support, and lectures on appropriate topics associated with addiction and recovery. 

Therapy And Counselling Modalities 

Therapy and counselling services are crucial in the treatment of substance use disorders and the foundation of inpatient treatment facilities. Remedi Medical Aid covers its members with several counselling modalities, including the following:

1. Individual counselling – patients receive specialised care and tailored programs to meet their needs.
2. Group Therapy – members will receive peer support and relate to shared experiences.
3. Family Therapy – These sessions address dysfunctional family dynamics and restore balance within home settings to make it conducive to recovery.

Exclusions and Limitations

While Remedi Medical Aid offers comprehensive coverage to its members, there are exclusions and limitations their members need to be aware of.

Covered Benefits

• Treatments only deemed medically necessary.
• Treatment for substance use disorders and approved inpatient rehab facilities.
• Treatment and plans provided by registered health care professionals.

Limitations

• Coverage Duration: Members are limited to 21 days of inpatient treatment, including a 3-day medical detoxification
• Remedi Medical Aid does not cover secondary treatment, and members will be liable to pay out-of-pocket should they wish to continue with the next phase of treatment after inpatient treatment.

Conclusion

Remedi Medical Aid aims to provide its members with quality care and treatment for their substance use disorders; as a result, they have made it a priority to ensure they are covered with a comprehensive list of addiction treatment services, including individual counselling, group therapy and family therapy. 

Additionally, a large portion of their members’ inpatient treatment stays are covered. Remedi Medical Aid has an extensive list of Designated Service Providers (DSPs) whose members can choose from when deciding on an inpatient rehab facility, making treatment accessible.

At We Do Recover, we aim to make our patients’ admissions a smooth and hassle-free process. Call us today, and we can start your admissions process on your behalf with Remedi Medical Aid.