Alcohol and Drug Rehabilitation Benefit on Medical Aid

Substance abuse is a problem worldwide and South Africans are not immune to this epidemic. Misuse and abuse of alcohol, prescription medication and illicit substances (street drugs) is a reality for every South African, irrespective of race, educational level or socioeconomic status. Often alcohol and drug rehabilitation is a necessity but it does not come cheap. State facilities are overburdened and semi-private or private rehabilitation can be very costly. Fortunately most medical aids in South Africa have a separate benefit for alcohol and drug rehabilitation undertaken by registered practitioners, counsellors and facilities.

Cost of Rehabilitation in South Africa

The cost of rehabilitation varies greatly in South Africa. It depends on the duration of the program, type of substance abuse and facility of choice. Rehabilitation does not end just after a few weeks or months. Recovery is ongoing through life like with any addiction. However, it is the early stages of rehabilitation that are the most crucial, and often the most expensive.

A 4 week stay (28 days) can cost anywhere between R10,000 to R150,000 depending on your location and facility. These costs can be even higher in exclusive addiction and rehabilitation centres catering for a very select clientele. Although most of these institutions cover the counselling, daily care, meals and other needs of the addict in this fee, sometimes you will have to pay more for added services. The bottom line is that without medical aid, rehabilitation can be financially crippling for most South African families.

Rehabilitation and Recovery in Hospital

Initially hospitalisation may be necessary. This may be related to an overdose or for detoxification as the supervising psychiatrist sees fit. However, medical aids have a very limited benefit in this regard for in-hospital costs. Once the addict is stabilised they will have to be discharged and continue rehabilitation in a separate facility out of a hospital setting. If the addict and their family wishes to stay in hospital beyond the period that a medical aid will pay for, then they will have to pay cash. Considering that private hospital fees in South Africa are exorbitant, this can prove to be a costly exercise.

The medical aid’s in-hospital psychiatry (mental health) benefit is not part of the general hospitalisation benefit on most plans. It is restricted to smaller limits, often around the R20,000 to R50,000 mark per family per year. This means that once you exhaust this benefit while hospitalised for psychiatric reasons, your medical aid will no longer pay for the bills you accrue when in hospital for mental health issues. Ultimately you will have to pay out of your own pocket. Given that this limit is per family, and not per medical aid member, it is best to limit the amount of hospital visits for psychiatric reasons.

With regards to addiction and rehabilitation, it is best to continue treatment in the out-of-hospital setting within a reputable alcohol and drug rehabilitation facility.

Medical Aid Addiction and Rehabilitation Assistance

Most people try to keep away mental health issues from their family and friends out of fear of the stigma. However, being untruthful to your medical aid about these issues is a disadvantage to you as a medical aid member. Firstly, a medical aid cannot discriminate against any person irrespective of their health status – this includes substance abuse and addiction. Secondly, most medical aids these days have become proactive about working with members for their health needs. Your medical aid may be able to advise you on helplines and recovery programs that you are not aware of. They will also be able to include medication such as antidepressants and antipsychotics on your chronic medication benefit, although newer addiction drugs like Subutex may be subject to restrictions.

By divulging your history to your medical aid, they will be in a better position to help you accordingly. The fact is that whether you tell your medical aid about your addiction or not, the rehabilitation benefit is not going to change. Neither are your monthly medical aid contributions. Your medical aid will pay for rehabilitation and recovery up to a certain limit in the year. This is only valid if you visit a reputable and registered facility manned by health care professionals. It not only ensures that you access reputable addiction services but also ensures that you do not waste your medical aid benefit on institutions without tried and tested rehabilitation and recovery programs.