Alcohol Treatment Coverage Under Medical Aid Plans

Alcohol Treatment Coverage Under Medical Aid Plans

Does your medical aid plan cover medically supervised detoxification and inpatient alcohol treatment, and what waiting periods or caps apply?


Bestmed-logo-dark-blue-light-blue

Bestmed Medical Aid provides coverage for alcohol abuse treatment for up to 21 days, including a 3-day medically supervised detoxication until benefits are capped.

The company recognises the seriousness of alcohol abuse and provides extensive coverage and a range of plans to meet its members’ diverse needs and budgets. Each plan has its terms, conditions, limitations, and exclusions; members must review their plans to understand their coverage.

At Changes Addiction Rehab, we have partnered with Bestmed to provide its members with exceptional treatment for their alcohol dependency, ensuring long-term recovery.

Key Takeaways

  • Bestmed covers alcohol rehab for up to 21 days with pre-approval
  • Coverage varies depending on the plan
  • Members must use approved facilities to receive full coverage

Eligibility For Alcohol Treatment Coverage

Members must meet specific criteria to receive coverage; coverage is available on all plans, but the extent will vary depending on the terms and conditions.

A pre-authorisation process must be adhered to before entering any alcohol treatment facility. Additionally, members must use Designated Service Providers (DSPs) contracted with Bestmed; this ensures that members will receive exceptional care and costs fall within the scheme’s limits.

Extent Of Coverage For Alcohol Abuse Treatment

Bestmed Medical Aid offers plans ranging from basic to comprehensive. The scheme covers inpatient rehabilitation programmes, outpatient services, detoxification and counselling sessions.

Limitations And Exclusions

All plans offered by Bestmed Medical Aid are subject to limitations and exclusions. Out-of-network facilities may not be covered or may result in a larger co-payment; it is recommended that the member choose one of Bestmeds approved facilities.

Additionally, Luxury rehabilitation facilities and alternative forms of treatment are not covered under the scheme’s policy.

Repeat treatments within a short period may face certain limitations. Bestmed Medical Aid covers up to 21 days of alcohol abuse treatment, including a 3-day medically supervised detox per year, running from January to January.

Alcohol Abuse Treatment Programs Covered

The plans cover inpatient treatment facilities, certain outpatient services and counselling sessions. Each type of programme caters to different needs and severity levels of alcohol abuse.

Inpatient Rehab Treatment

Changes Addiction Rehab provides a highly structured environment with 24-hour care. Patients reside in our facility for a set period. This intensive approach is set in place to ensure individuals receive the best treatment and are free from distractions.

Bestmed Medical Aid extends cover to licensed facilities that offer services such as:

  • Medically Supervised Detoxes
  • Group Therapy Sessions
  • Individual Counselling

It is important to note that coverage is subject to pre-authorisation, and members may be liable for a co-payment upon admission.

Outpatient Treatment Program

The outpatient rehab program serves as a transitionary phase of treatment after completing the inpatient rehab program. An outpatient program is a suitable option for members who need to attend to daily duties and responsibilities while still receiving an adequate level of treatment.

Bestmed Medical Aid may cover these treatments offered at the outpatient program:

  • Individual Counselling
  • Group Therapy

Counselling And Therapy Coverage

Counselling and therapy play a pivotal role in residential rehab treatment facilities. Bestmed Medical Aid provides benefits for these services. However, members must review their plans to understand the full extent of their coverage.

At Changes Addiction Rehab, our multidisciplinary team provides our clients with a holistic approach to treating alcohol use disorder.

Some of the therapeutic modalities used at our facility include:

  • Cognitive Behavioural Therapy
  • Motivational Enhancement Therapy
  • Family Therapy Sessions
  • Group Therapy

The number of sessions covered will vary depending on the plan chosen.

Claims Process For Alcohol Treatment

Claiming back for alcohol rehab treatment is quick and easy. Once you’ve received your treatment, simply gather your receipts and any other relevant documentation and submit a claim through their online portal. If you have any questions or need assistance, our team at Changes Addiction Rehab is here to help.

Pre-Authorisation Process

Members must adhere to specific guidelines to receive coverage for residential inpatient treatment.

At Changes, we handle the pre-authorisation process on your behalf, making admission into our facility more comfortable. This process involves contacting Bestmed Medical Aid and providing them with your details, including your ICD-10 codes and other relevant information, as well as our facility’s practice numbers. Importantly, a referral letter from a medical professional is not required.

Conclusion

Bestmed Medical Aid is committed to providing its members with extensive coverage for their alcohol addiction, demonstrating our care and commitment to their well-being.

Members can also benefit from individual counselling, group therapy, and the specific services offered by the outpatient program.

At Changes Addiction Rehab, we understand that coming into rehab treatment can be a hard decision to make, but it takes courage to admit you have a problem. Call us today to begin your pre-authorisation.

FAQs

Does Bestmed Medical Aid Cover Secondary Treatment?

No, they do not cover secondary treatment. Members will be liable to pay out-of-pocket fees.

Is The Outpatient Program Covered?

Coverage applies to specific services offered in the outpatient program, such as individual counselling and group therapy. It is important to note that the entire outpatient program is not covered.

Will Bestmed Medical Aid Cover Halfway Housing?

No, halfway houses are not covered. Members will be liable to pay private fees.

Does Bestmed cover inpatient substance abuse treatment and detox?

Yes. Bestmed provides cover for inpatient substance abuse treatment under its hospital/mental health benefits, with up to 21 days’ stay per year for in-hospital management.

What outpatient or therapy benefits does Bestmed offer for addiction?

Bestmed may cover outpatient psychotherapy, counselling sessions and therapy contact sessions subject to plan rules, DSP use, and pre-authorisation.

Is pre-authorisation required for rehab treatment with Bestmed?

Yes. Pre-authorisation is needed. You must follow scheme protocols, use DSPs when required, and submit appropriate documentation (ICD-10 codes, practice numbers) to gain approval.

Related Questions

Will my medical aid cover a medically supervised alcohol detox or just emergency stabilisation?

Short answer: it depends — and the difference matters. Emergency stabilisation (acute withdrawal that is life‑threatening) is treated under Prescribed Minimum Benefits if it meets the legal definition of an emergency; routine, planned medically supervised detox is usually funded from your in‑hospital or mental‑health benefit and needs prior authorisation. Schemes will look for objective clinical evidence (CIWA‑Ar scores, recent fits/delirium, comorbid medical or psychiatric conditions, documented failed outpatient attempts) and an ICD/DSM diagnosis (for example F10.2 — alcohol dependence; F10.3 — withdrawal). If you present to an emergency department they must stabilize you, but ongoing inpatient detox will typically require a motivation from a specialist and pre‑approval. Don’t assume automatic cover — get a clear clinical assessment and pre‑authorisation before admission whenever possible.

How do waiting periods and pre‑existing condition rules actually affect cover for alcohol treatment?

Medical schemes commonly apply general waiting periods and look‑back rules for pre‑existing conditions. Many plans have a short general waiting period (often three months) and longer waiting periods for pre‑existing conditions or mental‑health/substance‑use benefits (commonly up to 12 months). If you joined the scheme with untreated or recent alcohol problems, the scheme may classify this as pre‑existing and delay funding. Late joiner penalties and plan‑specific exclusions can also kick in. The practical step is to get the scheme’s rules in writing: request the benefit schedule, waiting‑period clauses and mental‑health addenda, then obtain a dated clinical assessment showing the onset and severity. That documentation is what you’ll use to argue your case or to apply for an exception.

What exact clinical paperwork will a scheme want before authorising an inpatient alcohol programme?

Prepare to hand over a medical file, not just a heartfelt letter. Schemes expect a formal referral from a treating clinician plus: a detailed clinical assessment (history of alcohol use, last drink, withdrawal history), objective withdrawal scoring (CIWA‑Ar or equivalent), medical and psychiatric comorbidity reports, current medication list, risk assessment (suicide, seizures, delirium), proposed level of care with a clear treatment plan and estimated length of stay, and an itemised cost estimate from the facility. If there’s a prior failed outpatient attempt or prior detox admissions, include those notes. For PMB queries include the ED record if applicable. A motivated addiction psychiatrist or physician who links clinical severity to the need for inpatient care will substantially increase approval odds.

What are the common caps and co‑payments I should expect, and how do I avoid nasty bills?

Schemes cap mental‑health and rehabilitation benefits in three ways: day limits (number of inpatient days per year), rand caps (a financial limit), or combined annual limits. You’ll often hit co‑payments if the facility charges above scheme tariffs, if you use a non‑DSP (Designated Service Provider), or if the scheme authorises fewer days than the clinician recommends. To avoid surprise bills: get written pre‑authorisation specifying the number of days and tariff accepted; choose a DSP where possible (or negotiate the facility tariff with the scheme beforehand); ask about any shortfalls or co‑payments in writing; and check whether gap cover or a special‑case application is available. If a scheme refuses full funding, escalate via the scheme’s case manager and, if necessary, file an internal appeal supported by updated clinical evidence.

Can my family insist on a specific Johannesburg facility, or will the scheme force a designated provider on us?

Many schemes steer members to Designated Service Providers to control quality and cost, and using a DSP usually minimises out‑of‑pocket exposure. However, you do not have to be shoved into an inappropriate setting. If a particular facility in Johannesburg is clinically indicated (for medical detox capability, dual‑diagnosis psychiatry, or safer medical staffing), obtain a written clinical motivation that explains why the DSP option is inadequate and submit it with your pre‑auth. Schemes have an exceptions or special‑case process; success depends on clinical justification and paperwork. Be blunt with the scheme: demand the clinical criteria they used to designate the DSP and show how your chosen provider meets those clinical needs. If the scheme still refuses, you’ll need to weigh the likely co‑payment against clinical risk — don’t sign the patient out early to save money without a clear medical plan.

Changes Addiction Rehab professional memberships and accreditations
© 2025 Changes Addiction Rehab of 216 Weltevreden Road. Northcliff, Johannesburg, South Africa

Content on this website is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Always speak to a qualified health professional about any medical concerns.
Changes Addiction Rehab PTY LTD (‎2013/152102/07) is licensed by the South African Department of Social Development (Practice No. 0470000537861) and the Department of Health, and is a registered detox facility and practice with the Board of Healthcare Funders. Our treatment programme is led by counsellors registered with the HPCSA, working alongside a multidisciplinary team of medical professionals under a unified practice. We are proud, standing members of the International Certification & Reciprocity Consortium (IC&RC), the Occupational Therapy Association of South Africa, the South African Council for Social Service Professions, the South African Medical Association, the South African Nursing Council and the South African Society of Psychiatrists. Changes Addiction Rehab has been in continuous professional operation since 2007, when it was founded by Sheryl Rahme, who has worked in the addiction treatment field since 1984. Our core clinical team brings over 100 years of combined professional addiction recovery experience.