Question 1

Does Polmed cover inpatient rehabilitation and detox?

Accepted Answer

Yes. Polmed provides cover for inpatient substance abuse rehab under its hospital/mental health benefits, subject to scheme rules, medical necessity, and authorisation.

Question 2

How many days of rehab does Polmed fund per year?

Accepted Answer

Polmed typically allows up to 21 days of inpatient rehabilitation (including detox), but this may vary based on your specific plan.

Question 3

Are outpatient or aftercare services covered by Polmed?

Accepted Answer

Outpatient services such as counselling, therapy or outpatient detox are generally excluded unless your plan explicitly includes them beyond PMB entitlements.

Question 4

What does Polmed require for pre-authorisation?

Accepted Answer

Pre-authorisation is mandatory. You must submit the patient’s medical aid details, ID, ICD-10 codes and practice numbers, and wait for scheme approval before admission.

Question 5

How do I make sure my scheme actually pays for the 21 days and the medically supervised detox?

Accepted Answer

Don’t assume the promise on paper equals an automatic green light. Start by calling your scheme and asking for the precise benefit rule, the product option, and whether the inpatient rehab and detox fall under the in-hospital limit, chronic benefit or Prescribed Minimum Benefits (PMBs) for your specific plan. You will need a pre-authorisation; submit it before admission with a clear clinical motivation from a medical doctor or psychiatrist that states diagnosis, withdrawal risk, medical necessity and proposed length of stay. Many schemes also insist you use an in-network facility to avoid co-payments. If you wait until after admission, you risk retrospective denial and large bills. Keep written proof of the scheme’s approval and the authorisation number; if the facility is doing the pre-auth for you, still insist on confirmation in writing from the scheme.

Question 6

What clinical records and findings will the scheme expect to approve a detox plus inpatient rehab stay?

Accepted Answer

Schemes want clinical substance, not family pleading. Provide a diagnostic assessment (DSM-5 or ICD code), baseline vitals and relevant labs, a documented history of failed outpatient attempts (if applicable), a withdrawal severity risk assessment, and a detox protocol signed off by a medical practitioner. If there are medical complications (liver disease, HIV, TB) or psychiatric comorbidity (depression, bipolar, psychosis) include recent psychiatric reports and medication lists. For extensions beyond the initial period, schemes require progress notes, multidisciplinary assessments (doctor, psychologist, occupational therapist) and a clear plan for step-down care. No single document guarantees approval, but a coherent, medically sound file reduces the chance of refusal.

Question 7

My scheme approved detox but cut the inpatient days—what are the realistic next steps?

Accepted Answer

This is common. First, obtain the scheme’s written motivation for the reduction so you can target an appeal. Ask the treating doctor to submit a re-authorisation with clinical progress notes and a justification for therapeutic days (group therapy, trauma work, neurocognitive stabilisation). If the denial appears to violate PMB rules or clinical necessity, escalate to the scheme’s internal appeal and lodge a formal dispute if needed. Parallel options families use: negotiate a short top-up (family pays the gap for specific days), move to a network provider that accepts the authorisation fully, or arrange affordable step-down care and intensive outpatient therapy. If you suspect wrongful denial of a PMB, you can lodge a complaint with the Council for Medical Schemes — but expect that process to take time, so arrange interim clinical care.

Question 8

How do co-occurring mental health disorders affect cover for the inpatient rehab and detox?

Accepted Answer

Co-morbidity changes everything clinically and financially. If there’s a concurrent major psychiatric disorder (severe depression, active psychosis, bipolar disorder), many schemes will consider the admission under a psychiatric admission benefit or PMB—but only if the diagnosis and medical necessity are clearly documented by a psychiatrist. That often increases the chance of cover for longer inpatient care, because the treatment goal becomes stabilising both substance use and psychiatric risk. On the flip side, unmanaged medical or psychiatric risks (suicidality, seizure disorder, severe cardiac issues) require a higher level of medical monitoring and might push towards a hospital or psychiatric facility whose billing structure the scheme treats differently. Make sure assessments are integrated: separate reports from psychiatrist, medical officer and psychologist improve approval odds and keep the care legally and clinically defensible.

Question 9

Can I force a loved one into the 21-day programme if they refuse to go?

Accepted Answer

Short answer: it’s complicated and rarely simple in private rehab. Forcing admission is legally controlled; involuntary admission under the Mental Health Care Act requires specific criteria — typically an inability to make informed decisions due to a mental disorder and a significant risk to self or others. Substance dependence alone usually doesn’t meet those criteria unless there is clear, documented danger or severe impairment. In practice, families use medically supervised interventions: consult a psychiatrist to assess capacity and risk, consider assisted admission provisions where clinically indicated, or arrange urgent motivational interventions to secure voluntary admission. If coercion is considered, get legal advice and clinical assessment first — acting without the proper legal or clinical framework can create more harm than benefit and may jeopardise funding from the scheme.

Medical Aid Covers Up To 21 Days Of Inpatient Rehabilitation

POLMED Medical Aid Coverage Overview

Network of Providers

Getting Treatment Authorised

Important Considerations

Does Polmed Cover Rehabilitation Centres?

Polmed’s Medical Aid Plans

Rehabilitation Centres and Services Covered by Polmed

Navigating Polmed Coverage for Rehabilitation

Does Polmed Cover Rehabilitation Centres

Member Experiences with Rehabilitation Services Through Polmed

Expert Tips for Maximizing Rehabilitation Coverage with Polmed

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FAQ: Polmed Medical Aid Rehab Cover