Inpatient Drug Abuse Treatment Covered By Medical Aid

Inpatient Drug Abuse Treatment Covered By Medical Aid

Does your medical aid cover inpatient drug abuse treatment, including a medically supervised detox and up to 21 days' inpatient care?


Remedi Health is a reputable medical aid scheme that provides up to 21 days of inpatient drug abuse treatment, including a 3-day medically supervised detoxification administered by a medical health professional.

Their plans range from essential to comprehensive and include a wide range of benefits for drug abuse treatment. However, all their plans are subject to limitations and exclusions that their members should know.

At Changes Addiction Rehab, we have forged a strong partnership with Remedi Health Medical Aid. This collaboration ensures that their members receive the highest standard of drug addiction treatment, leading to long-term recovery. This article will address any questions about the plans Remedi Health offers.

What Drug Abuse Treatments Does Remedi Health Cover?

Substance use disorders are complex and need to be treated using an integrated approach. Remedi Health recognises this and offers extensive coverage so members can receive the required help.

The subsections below will discuss what Remedi Health covers for drug abuse treatment.

Residential Inpatient Treatment For Drug Abuse

Legally, Remedi Health Medical Aid must pay for up to 21 days of residential inpatient treatment, including a 3-day medically supervised detoxification, once yearly, from January to January.

Members must choose a drug abuse treatment centre from one of the designated service providers (DSPs) to receive their full benefits. Failure to do so will result in a larger co-payment upon admission.

Outpatient Treatment Services

Outpatient treatment is ideal for members who have completed their treatment at primary care. They will be able to tend to their daily responsibilities, such as work, school, and relationships, while still receiving drug abuse treatment.

Remedi Health Medical Aid only pays for specific services, not the entire program. For example, individual counselling sessions can be claimed for by Remedi Health members.

Individual Counselling And Therapies

Individual counselling sessions are a cornerstone of addiction treatment centres. Individuals can gain valuable insight into their maladaptive addictive behavioural patterns and adopt healthy coping mechanisms to deal with their drug abuse disorder.

Members can claim individual counselling sessions and group therapy sessions through Remedi Health. However, members must review their plans to determine the extent of their coverage, as different plans offer different benefits.

Pre-Authorisation Process for Remedi Health Medical Aid

At Changes Addiction Rehab, we prioritise our patient’s emotional well-being, so we will do the pre-authorisation process on your behalf. The procedure is quick and straightforward and should take at most 10 minutes.

We will call Remedi Health and provide them with our facility’s practice numbers and your ICD-10 codes; there is no need for a referral letter from a doctor.

Exclusions And Limitations

While all Remedi Health members may have comprehensive benefits, their plans are subject to specific exclusions and limitations.

Here is what they look like:

  • Remedi Health Medical Aid will not cover treatment that a medical health professional does not deem necessary.
  • Remedi Health Medical Aid does not cover alternative forms of therapy, such as homoeopathic treatments and yoga therapy.
  • Remedi Health Medical Aid will not cover treatment at non-registered facilities.
  • Remedi Health Medical Aid will not cover treatment that was not pre-approved.
  • Remedi Health Medical Aid does not cover secondary and tertiary phases of treatment, and members must pay privately for those services.
  • Remedi Health Medical Aid does not cover process addictions like gambling and porn addictions. If a member wants to be treated for those addictions, they will need to be referred to a psychiatric facility.

Conclusion

Remedi Health Medical Aid understands the complexity and severity of drug addiction and aims to provide its members with comprehensive treatment for their substance use disorders. Over and above this, members receive a large amount of addiction treatment benefits such as individual counselling and group therapy sessions they can claim for.

At Changes Addiction Rehab, we understand that drug and alcohol abuse is a tough battle to fight, which is why we are here to help you win the war.

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

FAQS

Does Remedi Health Cover Secondary Drug Abuse Treatment?

No, Remedi Health Medical Aid does not cover secondary care, and members will have to pay out-of-pocket fees to get this treatment level.

How Many Days Of Inpatient Rehab Treatment Does Remedi Health Medical Aid Pay For Per Year?

Remedi Health Medical Aid pays for up to 21 days of inpatient treatment per year, including a 3-day medically supervised detoxification.

Does Remedi Health Medical Aid Cover Therapy?

Yes, Remedi Health Medical Aid covers a certain number of therapy sessions per year; this coverage is plan-dependent, so members must review their plans to determine their coverage.

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Related Questions

How can I tell if my medical aid will actually pay for a medically supervised detox and up to 21 days’ inpatient care?

Don’t assume the answer is yes just because your plan says it covers “inpatient rehab.” In South Africa the decisive tests are clinical necessity and whether the case meets Prescribed Minimum Benefit (PMB) or the scheme’s internal rules. For an acute, potentially dangerous withdrawal (severe alcohol withdrawal, benzodiazepine or opioid withdrawal with high risk factors) schemes will usually fund a medically supervised detox as a PMB if your doctor documents the emergency or risk. For planned residential treatment up to 21 days, many schemes fund it if you get pre-authorisation with a clear specialist assessment, a multidisciplinary treatment plan and evidence that outpatient care was unsafe or previously failed. In Johannesburg that means your GP or psychiatrist needs to send the scheme: an ICD-10 substance-related diagnosis, withdrawal risk assessment, admission notes, and a named treating specialist. If they ask for short-term funding only, push them for the clinical reasons for the limitation and get the treating team to write a targeted motivation.

What exact clinical paperwork will the scheme demand before authorising inpatient care — and who should prepare it?

Schemes are looking for proof that inpatient care isn’t convenience. Prepare: (1) a specialist psychiatric or addiction medicine report with ICD-10 code (F10–F19 series), (2) a documented withdrawal risk score and physical exam, (3) a clear treatment plan showing objectives for detox and up to 21 days’ care, and (4) supporting notes from a GP, social worker or psychologist if available. The treating facility (or the admitting psychiatrist) should compile this and submit it with the pre-authorisation request. Don’t hand over loosely written notes — schemes deny vague files. If there’s co-morbidity (depression, psychosis, HIV, TB), include those records: dual-diagnosis increases the clinical justification for inpatient care and changes how the scheme assesses medical necessity.

If my scheme approves only 21 days or refuses extended inpatient treatment for a complex case, what realistic options do families in Joburg have?

First, ask for an internal appeal and an independent clinical peer review — get the treating psychiatrist to provide a detailed motivation for an extension with measurable clinical targets. If the scheme still refuses, you can escalate to the Council for Medical Schemes (CMS) or request a PMB dispute resolution, but that takes time. Practically, families often combine partial scheme funding with out-of-pocket top-ups for a private extension, or move the patient into a step-down option: day programmes, intensive outpatient therapy, or a medically supervised halfway house. Also explore NGO subsidised services and community psychiatric services in Gauteng for follow-up care. Be realistic: complex, dual-diagnosis patients often need more than 21 inpatient days — plan ahead for funding or staged care rather than relying on a single authorisation.

Will my medical aid cover the medicines used during detox and longer-term opioid substitution therapy (methadone/buprenorphine)?

Medicines used during an inpatient detox (IV fluids, benzodiazepines for alcohol withdrawal, antipsychotics if needed) are generally covered as part of the hospital admission. Where schemes get fussy is with ongoing medication after discharge — especially opioid substitution therapy (OST). Many schemes won’t list methadone or buprenorphine on their chronic medicine lists by default, meaning you may pay out of pocket unless there’s a clear PMB case or prior authorisation. Pharmacies and hospital formularies differ: hospital-supplied medicines during admission are usually covered, but maintenance OST from a private prescriber often isn’t. If OST is clinically indicated, insist that your treating physician include it in the motivation and ask the scheme to consider it under chronic care or a PMB if dependence meets the required criteria.

What common financial and administrative traps do Johannesburg families fall into when using medical aid for inpatient addiction treatment?

Families assume 'authorised' equals 'fully paid' — it doesn’t. Expect possible shortfalls when the facility charges above the scheme tariff, co-payments for non-network providers, and separate charges for specialist or psychologist sessions. Some schemes limit the number of admissions per year or refuse coverage for readmissions without a fresh motivation. Waiting periods don’t apply to genuine PMB emergencies, but schemes will scrutinise whether the condition meets PMB rules — sloppy documentation kills claims. Also note aftercare costs (day programmes, therapy, family counselling) are often not covered or fall under different benefits. Before admission, get the scheme’s written authorisation, ask for a cost estimate including likely shortfalls, and make sure the facility’s billing department will engage the scheme directly — otherwise you’ll be negotiating the bill while dealing with clinical crisis.

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Changes Addiction Rehab 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.