Momentum Rehab Johannesburg

Momentum Rehab Johannesburg covers using your medical aid for addiction treatment. The authorisation process is set out on rehab with medical aid insurance. This page deals with the number nobody asks about until the invoice arrives: the shortfall.

Momentum Rehab Johannesburg: Where the Shortfall Comes From

A scheme pays at its rate. A facility charges its fee. Where the second is higher, the difference is yours. Authorisation being granted says nothing about whether the full cost is covered, and members routinely read "authorised" as "paid in full".

Shortfalls typically arise from four places: the gap between scheme rate and facility fee; using a facility outside the scheme's network; items billed separately such as psychiatric consultations, medication and pathology; and days beyond the authorised number.

Getting the Number Before You Admit

• 1
  Ask the facility for its full fee for the expected admission, including what is billed separately.
• 2
  Ask the scheme what it will pay for that admission at that facility.
• 3
  The difference is your shortfall. Get both figures in writing.
• 4
  Ask what happens if an extension beyond the authorised days is needed.

Does Gap Cover Help?

Gap cover is a separate insurance product that pays the difference between scheme rates and provider charges. Whether it applies to a rehab admission depends entirely on the policy wording, and some gap products exclude psychiatric and substance use admissions outright.

If you hold gap cover, read the exclusions and confirm with the gap provider directly rather than the medical scheme - they are different companies with different answers. Do this before admission, because a claim declined afterwards leaves you with the full difference.

Prescribed Minimum Benefits

Substance use disorders sit on the Prescribed Minimum Benefits list that every scheme must cover to a defined minimum, subject to designated providers and scheme protocols. PMB sets a floor; it does not guarantee a facility's full fee will be met.

If the Shortfall Is Unaffordable

Before reducing the level of care to fit the budget, speak to Drug Rehab Johannesburg about facilities whose fees sit closer to scheme rates.

Options: a facility whose fee sits closer to the scheme rate, a shorter admission with stronger aftercare, an outpatient level of care where clinically appropriate, a payment arrangement, or a state or NGO route. See affordable rehab and rehab without medical aid insurance. What is not advisable is choosing a lower level of care than the assessment indicates purely on cost - that usually ends in re-admission and a second bill.

Frequently Asked Questions