Netcare Medical Aid is one of the leading healthcare providers in South Africa. Members can receive treatment for substance misuse for up to 21 days of inpatient treatment, including a 3-day medically supervised detoxification per year, running from January to January.
Netcare Medical Aid recognises the severity of addiction and offers comprehensive coverage to its members to combat this. While their plans may have limitations and exclusions, members can be confident that they will be covered for addiction treatment as it falls under the prescribed minimum benefits (PMBs); no matter what plan a member is enrolled on, they will be covered.
At Changes Addiction Rehab, we have joined forces with Netcare Medical Aid to ensure that its members receive a superior level of care and treatment for their substance use disorders. This partnership is a testament to our commitment to your well-being and recovery.
Substance Misuse Treatments Covered By Netcare Medical Aid
Netcare Medical Aid Scheme provides its members extensive drug and alcohol rehabilitation coverage.
Their plans range in pricing and comprehensiveness, ensuring that all their members’ needs and budgets will be met.
Residential Inpatient Treatment
Inpatient rehab is vital to the treatment of severe substance use disorders. Individuals undergo intensive care in a safe and secure environment, void of triggers and distractions, ensuring long-term sustainable recovery.
Netcare Medical Aid covers up to 21 days of inpatient rehab treatment, including a 3-day medically supervised detoxification once per year.
It is important to note that members may be liable to a co-payment upon admission, as Netcare may only pay a portion of the inpatient treatment stay.
Outpatient Treatment Services
The outpatient program is designed for individuals who need to attend to responsibilities outside of treatment, like work and school, while still receiving treatment for their addiction.
Members of Netcare Medical Aid can claim specific services from the outpatient program, such as individual counselling.
Netcare does not pay for the entire outpatient program.
Counselling and Therapy
Individual counselling and therapy play a significant role in an individual’s recovery trajectory. Luckily, Netcare Medical Aid covers individual counselling and group therapy sessions.
Members will receive different benefit caps depending on the type of plan they are enrolled in.
Exclusions And Limitations
Netcare Medical Aid’s plans offer comprehensive coverage to its members. However, all plans are subject to limitations and exclusions.
Exclusions
Netcare will not provide coverage for addiction therapy that is not deemed medically necessary by a healthcare professional, such as homoeopathic approaches.
Process addictions like gambling, sex and porn addiction are not covered at drug and alcohol rehab facilities. If a member wishes to seek treatment for these addictions, they will need to be transferred to a psychiatric facility.
Lastly, Netcare Medical Aid will only provide coverage for registered facilities that have been approved through a pre-authorisation process.
Benefit-Caps
Each plan offered by Netcare Medical Aid will have terms and conditions specific to that plan. For example, a member on a basic plan will have different benefits than a member on a more comprehensive plan.
Members on a comprehensive plan may receive more benefits from psychology sessions per year.
Member should carefully review their plans to understand their coverage limitations and benefit caps.
Pre-Authorisation Process
Netcare Medical Aid Covers inpatient rehab treatment; however, to receive this coverage, a member must adhere to a pre-authorisation procedure to gain approval.
At Changes Addiction Rehab, we prioritise our client’s well-being and want their transition into primary care to be smooth, which is why we do the pre-authorisation process on your behalf.
We will call Netcare Medical Aid and provide them with all the necessary details, including the ICD-10 codes for your specific addiction and our facility practice numbers.
Lastly, you will not need a letter of motivation from a healthcare professional to be admitted into drug and alcohol inpatient rehab.
Claims Procedure For Netcare Medical Aid
Members can submit their claims for the addiction treatment they received to Netacre Medical Aid; they will need to include their supporting documentation, which can contain invoices, treatment plans and medical reports.
Once Netcare Medical Aid receives the claim, it will undergo review. If approved, the member will be reimbursed for the amount claimed.
Conclusion
Netcare Medical Aid aims to provide its members with quality healthcare coverage. To live up to this promise, they provide coverage for up to 21 days of inpatient treatment, including a 3-day medically supervised detoxification.
Over and above that, members are provided with comprehensive coverage for therapy sessions, ensuring long-term recovery. Their plans may have limitations and exclusions, but their coverage is extensive.
At Changes Addiction Rehab, we understand that the admin behind the pre-authorisation process can be overwhelming, so we can do it for you. Call us today at 081-444-7000.
FAQS
How Many Days Of Inpatient Rehab Treatment Is Covered By Netcare Medical Aid?
Netcare Medical Aid covers up to 21 days of residential inpatient treatment, including a 3-day medical detox. However, members may be liable to a co-payment upon admission.
Does Netcare Medical Aid Cover Halfway Houses?
No, Netcare does not cover halfway houses. Members will be liable to pay privately for this phase of treatment.
Does Netcare Provide Coverage For The Outpatient Program?
Netcare Medical Aid only covers specific outpatient program services, such as individual counselling, not the entire program.