Medical Aid Covers Up To 21 Days Of Alcohol Rehab

Medical Aid Covers Up To 21 Days Of Alcohol Rehab

Could your medical aid's 21 days of inpatient coverage, including a three day medically supervised detox, meet your recovery needs?


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La Health members are covered for their alcohol abuse disorder for up to 21 days in an inpatient rehab facility, including a 3-day medically supervised detoxification administered by a registered healthcare professional.

Substance use disorders are complex and multifaceted and need to be treated with an integrated approach to ensure long-term recovery. LA Health recognises the severity of addiction and offers comprehensive coverage to its members with varying plans and prices to suit different income brackets.

Medical Aid Plans, their coverage, benefits, limitations and exclusions may seem overwhelming, which is why the team at Changes Addiction Rehab have compiled this article to explain what the LA Health Medical Aid Scheme has to offer its members in terms of addiction rehab treatment coverage.

Alcohol Rehab Benefits

Members who struggle with alcohol abuse disorder can receive up to 21 days of inpatient treatment coverage; this includes a 3-day medically supervised detoxification.

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Alcohol Detoxification

The detox from alcohol is an integral part of the treatment process for alcohol abuse. However, it should be noted a detox does not equal recovery and should instead be viewed as a stepping-stone to the next phase of treatment.

Detoxification is implemented to help individuals remove substances from the body while simultaneously treating the psychological symptoms and aftermath.

We offer an individualised approach at Changes Addiction Rehab as each patient’s needs and situation are considered; they will undergo a medical assessment to determine the severity of their condition and be administered a personalised detox.

During detoxification, patients may experience uncomfortable withdrawal symptoms; our round-the-clock medical health professionals will be there to monitor and offer support through the process.

Residential Alcohol Rehab

LA Health Medical Aid Scheme covers up to 21 days of inpatient treatment for substance abuse. However, members may be liable to a co-payment upon admission, as LA Health only pays a portion of residential rehabilitation.

Counselling And Therapy

Members can receive therapy session benefits for their alcohol abuse disorder.

LA Health offers a range of differing plans, from essential to comprehensive. Comprehensive plans provide more extensive benefits and may include more annual sessions and specialist visits.

Changes Addiction Rehab employs different therapeutic modalities to combat alcoholism and drug addiction, which manifests as a multifaceted, chronic brain disease.

These modalities include:

  • Cognitive-Behavioural therapy (CBT)
  • Dialectical Behavioral Therapy (DBT)
  • Motivational Enhancement Therapy
  • Family Therapy
  • Group Therapy

Members can claim for these individual sessions through LA Health.

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Outpatient Treatment Services

The outpatient treatment program is a transitionary phase of treatment after inpatient rehab. The ideal candidate for the outpatient program would have completed residential treatment and is ready to return to their responsibilities.

LA Health only covers specific services in the outpatient program, such as individual counselling.

How To Qualify For Coverage Through LA Health Medical Aid

For members to reap the full benefits from their claims, they should seek treatment at one of the designated service providers on the list offered by LA Health; if a member chooses a facility that is not on this list, they will be liable to a larger co-payment.

Lastly, a pre-authorisation process must be followed meticulously to receive coverage in an inpatient treatment facility. If the pre-authorisation is not approved, members will not receive coverage.

Claims Submission

Claims can be submitted to LA Health for reimbursement; supporting documentation such as relevant invoices, treatment plans, and medical reports need to be submitted alongside the claim forms, which can be found on the LA Health website.

Limitations And Exclusions

The plans offered by LA Health are subject to limitations and exclusions.

These include the following:

  • The number of days a member will receive coverage is limited.
  • LA Health does not cover secondary and halfway house phases of treatment, and members will be liable to pay privately.
  • LA Health does not cover non-registered facilities
  • Treatments that are not deemed medically necessary.
  • Alternative forms of treatment.

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The Pre-Authorisation Process

The pre-authorisation process to receive coverage from LA Health into a primary care facility for alcohol abuse is straightforward.

At Changes Addiction Rehab, we can do this procedure on your behalf. Once you call our facility, we will forward you to our admissions department. They will call LA Health and provide them with your ICD-10 codes and our facility’s practice numbers. The good news is that you won’t need a letter of motivation from a healthcare professional to be admitted.

Conclusion

LA Health Medical Aid offers extensive coverage to ensure that members get the care that they need for their substance use disorders.

Additionally, their plans range in comprehensiveness and pricing to accommodate their member’s diverse individual needs and budgets, making them accessible.

At Changes Addiction Rehab, we have a multidisciplinary clinical team to provide our patients with quality treatment for their addictions, making sure they have a fighting chance at long-term sustainable recovery.

Call us today at 081-444-7000 to start your pre-authorisation process.

FAQS

Does LA Health Offer Basic Plans?

The LA Health KeyPlus Plan is affordable, and members can receive addiction treatment coverage.

Can I Recieve Coverage For Alcohol Detoxification Through LA Health Medical Aid?

LA Health is legally obligated to cover 21 days of inpatient rehab treatment, including a 3-day medically supervised detoxification per year as it falls under the prescribed minimum benefits (PMBs).

Does LA Health Medical Aid Cover More Than One Inpatient Stay Per Year?

No, LA Health only covers one residential inpatient treatment stay per year.

FAQ: LA Health Medical Aid Rehab Cover

Does LA Health cover addiction treatment including detox?

Yes. LA Health covers up to 21 days of inpatient rehabilitation per year. This includes a medically supervised detox of up to 3 days, subject to plan rules and pre-authorisation.

What outpatient or therapy benefits does LA Health provide for addiction?

LA Health plans often include counselling, psychiatrist or psychologist visits, and therapy sessions as part of outpatient care. Benefits depend on the plan option and authorisation.

Does LA Health require pre-authorisation for rehab treatment?

Yes. Pre-authorisation is required. Changes Addiction Rehab assists with practice numbers and ICD-10 codes to secure approval and admission dates.

References

Related Questions

Can 21 days (with a 3‑day medically supervised detox) actually be enough for alcohol dependence?

Short answer: sometimes — but don’t let the number dictate clinical decisions. The three‑day detox is about stabilising withdrawal symptoms and preventing seizures or delirium tremens; it is not psychotherapy or long‑term relapse prevention. For mild, recent dependence with good social support and no major psychiatric or medical comorbidity, a tightly run 21‑day inpatient programme plus structured outpatient follow‑up can be clinically effective. For long‑standing dependence, heavy daily drinking, prior withdrawals or DTs, significant liver disease, or suicide risk, 21 days is often only the first phase. Clinicians will use objective measures (history of withdrawals, CIWA‑Ar scores, liver function, cognitive screening, urine drug tests) to judge if the scheme’s limit is medically appropriate. If you’re in Johannesburg and your family is footing the logistics, insist on a clear, written clinical assessment on day one that states whether 21 days is sufficient and what measurable goals must be met before discharge.

What actually happens in those three days of medically supervised detox — what should families expect to see or worry about?

The three days are focused on safety. Expect symptom monitoring (CIWA‑Ar), regular vital signs, and medications to blunt withdrawal—most commonly benzodiazepine protocols tapered to prevent seizures—plus thiamine and other vitamins to protect the brain. We check electrolytes, liver enzymes and, if indicated, do an ECG. High‑risk patients may need longer observation or ICU transfer; low‑risk patients can be stabilised and moved into the therapeutic programme. Families should watch for post‑detox confusion, sleep disruption and severe anxiety — these are common and require clinical follow‑up, not finger‑pointing. Ask the treating team for the detox medication plan, seizure precautions, and the criteria they’ll use to declare you medically stable.

My medical aid approved 21 days — how do I avoid being discharged with no real aftercare or being bounced back into a high‑risk environment?

Don’t accept a discharge date without a detailed aftercare plan. A proper plan names outpatient appointments (dates and clinicians), medication scripts with private prescribers listed, community groups (AA, SMART, therapist contact), and, if needed, a transitional sober living address. If your scheme won’t fund step‑down care, negotiate for home‑based or day programmes in writing and get a social worker to coordinate family involvement. Insist the facility documents relapse triggers, a clear crisis plan (who to call, where to go), and a family briefing before discharge. In Joburg, transport and safety back into certain neighbourhoods matter — make that part of the discharge logistics. If the facility refuses reasonable aftercare, escalate to the scheme with the social worker’s notes attached.

If there’s co‑existing depression, trauma or a substance mix, will the 21 days cover meaningful psychiatric treatment?

Coverage varies; medically, dual diagnosis requires concurrent treatment. The inpatient stay should include a psychiatric assessment, risk management, and initiation of evidence‑based meds when indicated (antidepressants, mood stabilisers, etc.), plus psychotherapy options tailored to trauma or personality issues. Realistically, many schemes limit psychology and psychiatry sessions or expect outpatient continuation after the inpatient block. If the psychiatric presentation is severe (psychosis, suicidal ideation, severe PTSD), you must document that ongoing inpatient care is clinically necessary — and be prepared to challenge denials. Families should ask for a written psychiatric formulation on admission and a medication handover on discharge so the treating GP or public sector psychiatrist in Jo’burg can pick up treatment immediately.

My medical aid declined or capped days — how do I appeal or cover the shortfall without bankrupting the family?

Start with a formal written motivation from the admitting psychiatrist or addiction specialist detailing clinical necessity, objective withdrawal risk, comorbidities and why outpatient care isn’t safe. Submit that to the scheme’s appeals office immediately. If the scheme still refuses, escalate to the Council for Medical Schemes and request an independent clinical review; keep all clinical notes and the detox/CIWA‑Ar records. Financially, ask the facility about a payment plan, gap cover, or a reduced‑rate package for the family; some Johannesburg centres will negotiate fees when a scheme limits cover. Also check whether your policy has a designated service provider (DSP) requirement — using a DSP can avoid out‑of‑pocket shortfalls. Don’t sign away clinical needs for short‑term savings; get the denial in writing and pursue the appeal while maintaining safety for the patient.

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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.