Medical Aid. Do they really care??

[adrianh]

I really need to clarify my standpoint on this matter. I think that it is great the this person is taking responsibility and trying to get off the drugs. I know how difficult it is to admit to having the problem and I know how hard it is to give up. I spent most of my high school career stoned (which nearly cost me my life...and still affects my health today). I support any and all efforts that are taken to rid oneself of addictions, be it drugs, cigarettes or whatever.

That said, I dislike the notion that addiction is treated like a disease. A person can choose to stop at any time whereas you cannot choose to stop having Hepatitis. I know that stopping is hard and that there is a lot more to it than a simple choice, but the reality is that a simply choice is what is needed.

Anyway, I'm sure that I come across as a hard@$$ shooting the guy down but that is not my intention. This person comes across, (at least to me) as an arrogant know-it-all and I am shooting down the attitude that I perceive, not the intention to give up taking drugs.

[HR Solutions]

This person comes across, (at least to me) as an arrogant know-it-all and I am shooting down the attitude that I perceive, not the intention to give up taking drugs.

I fully agree with you. I don't agree with drugs but I suppose he is trying to give up .... . But the problem is that when someone was on drugs and has given up or is trying to give up, they think they are a big hero. But in the same instance whenever someone dares say something that they don't like they are quick to retaliate as in this case and they don't like the answers given. Personally my take on it is if you want to give up you have to first of all want to from yourself, you then have to listen to other people ........... because really you haven't listened in the past ....... thats why you are on drugs. But really its up to you - if you don't want advice or listen to people thats his choice and he must get on with it.

[Rafael]

It doesn't matter if you have had a medical aid for 9 years or 6 months. Non-disclosure is non-disclosure.

I signed a client in October 2014 (who was without a medical aid for 2 years), I went through the medical questions and it was no for everything. I got a phone call last week saying that her daughter needs to see a psychiatrist and if we can cover it, when the medical investigated we found out that the daughter had been to see a psychiatrist last year June. So we repudiated the claim.

You always disclose everything on a medical aid application.
Your medical aid unfortunately has every right to refuse a claim, what you can do try do is take is up with the council for medical schemes

One a side note
If you do have life cover, and you answered no to taking drugs. Please note that that will also be repudiated due to non disclosure

[adrianh]

Both HR and I question whether medical aids should foot the bill given that it is self inflicted.

@Rafael

1. Do medical aids cover the cost of rehab?
2. Is drug addiction not considered to be self inflicted?
3. What happens if the person relapses and wants to go back to rehab?

[coells]

Ok... adrianh and HRS lets take a quick look at your first posts:

Just a question. Yes good for you for kicking the habit, but medical aids are business people like a lot of us. I am on a medical aid - why should I pay a higher premium because some people (like yourself maybe) that is trying to kick a self induced habit and now needs to stop ? Because if everyone is allowed to just do anything and then claim from the medical aid our premiums would go up and up and up ..... Just my thought and answer to your question above and I think I have a valid point as much as you think you have a valid point.

PS somewhere along the line someone will pay for it and be penalised - why should it not be you ?

and

Lets look at it from a totally different perspective. You spent a hell of a lot of money on your addiction....why should they foot the bill for you to kick your addiction? I can't think of any insurance on medical aid that will pay for self-inflicted harm, they have the right not to insure you against your own stupidity.

I also don't see how going to rehab could be considered to be medical treatment, should the medical aid pay for people who are addicted to gambling?

There is no answer or advice in these two posts. All you doing is complaining about complaining about what it might cost YOU if the medical aid approves treatment and dismissing my problem as something trivial and not worth the time!

if you don't want advice or listen to people

if I had to take your "advice" and listen to you then I might as well just give up. The two of you have not said anything that I can use or apply you've only whined and shot me down. I listen and take advice when people like Houses4Rent actually makes sense. Not just fart and think people must accept it as advice!

[coells]

It doesn't matter if you have had a medical aid for 9 years or 6 months. Non-disclosure is non-disclosure.

I signed a client in October 2014 (who was without a medical aid for 2 years), I went through the medical questions and it was no for everything. I got a phone call last week saying that her daughter needs to see a psychiatrist and if we can cover it, when the medical investigated we found out that the daughter had been to see a psychiatrist last year June. So we repudiated the claim.

You always disclose everything on a medical aid application.
Your medical aid unfortunately has every right to refuse a claim, what you can do try do is take is up with the council for medical schemes

One a side note
If you do have life cover, and you answered no to taking drugs. Please note that that will also be repudiated due to non disclosure

Thanks for the info Rafael. I won't take it to the medical schemes counsel because I know they can are allowed to refuse my request. I was thinking morally it's a questionable action but then morals and business don't really go together in the same sentence do they?

[adrianh]

hmmm....aye well...you have all the answers so all I can do is wish you well!

[HR Solutions]

hmmm....aye well...you have all the answers so all I can do is wish you well!

Yep so do I.

So in other words you wanted everyone to agree with you from your first post ! And you can't understand when people ask you a question back !
Did you perhaps take too many this morning ...... if you don't understand this !

[coells]

Did you perhaps take too many this morning ......

Oh very mature HRS... how old are you? 5?

[Rafael]

Both HR and I question whether medical aids should foot the bill given that it is self inflicted.

@Rafael

1. Do medical aids cover the cost of rehab?

2. Is drug addiction not considered to be self inflicted?

3. What happens if the person relapses and wants to go back to rehab

1. Do medical aids cover the cost of rehab?

Most Medical aids do cover Rehabilitation for alcohol and/or drug abuse.
It is subject to authorisation and meeting the Scheme's clinical entry criteria.
They wont pay for extended care, normally just the first line of treatment.


2. Is drug addiction not considered to be self inflicted?

Yes, but by not treating the cause it could lead to the Medical Aid paying a lot more down the line.
Council of medical schemes govern our medical schemes and they PMB's (Prescribed minimum benefits) that medical aids have to cover therefore insuring adequate treatment for all no matter what scheme you on.

These are

- any emergency medical condition;
- a limited set of 270 medical conditions;
- and- 25 chronic conditions.

So if a drug user ends up in ICU or a coma for weeks, the medical aid will end up paying a lot more than it would have if it had just treated the addiction.

3. What happens if the person relapses and wants to go back to rehab? [/QUOTE]

They will have to get Authorization, It will also depend on the limit they have left under Rehab (some plans cover up to R21 000 per year)