Will My Medical Aid Cover My Treatment ?

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Will My Medical Aid Cover My Treatment ?

25 September, 2020Articles, News

“Will my medical aid cover my treatment?” is a question we hear incredibly often at Crossroads , and generally, the answer is yes, with a few exceptions. This blog will go into the if, why and how your medical aid or hospital plan can assist you in getting treatment.

What are PMB’s ?

Prescribed Minimum Benefits are features of The Medical Schemes Act that ensures every member has access to basic health care services. A medical aid legally has to cover these to the bare minimum, if they want to be registered with the Council for Medical Schemes. They apply regardless of what the scheme is, which means that even hospital plans have these benefits included.
In the case of rehabilitation, the focus from a doctor’s point has to be diagnostic, this means that the duration or cause of the illness does not determine the validity of treatment. This also means that rehabilitation for illegal drugs is not any different from treatment for legal ones, such as over the counter medications or alcohol.

How much do they cover ?

The rules set forth by the Council of Medical Schemes dictate that rehabilitation should be covered for up to 3 weeks. Some medical aids also make detoxification benefits available when combined with rehabilitation. The monetary value of these benefits does vary from scheme to scheme, with some paying out more than others. This does not impact on the ability to use these benefits but is rather associated with how much the co-payment will work out to.

Under what circumstances will your medical aid not pay ?

There are a few things that will exclude you from using these benefits, which are listed below:

If you are on a waiting period: Generally, when you join a medical aid for the first-time, certain benefits are excluded from the scheme. This is so that people don’t take advantage of the medical aid – join on one day, use the benefits and then cancel the next day. This all varies from scheme to scheme and differs for individuals. Speak to your broker or call the customer care line for clarity.

If there are exclusions on your medical aid: Some medical aids offer budget options. This may limit your options for treatment to certain hospitals and doctors. This may apply to rehabilitation centres as well. Though we do see this from time to time, what we see more often is “medical insurers” who do not need to conform to the same rules as medical aids when it comes to prescribed minimum benefits.

If you have used your benefits: Medical aids limit the benefits associated with certain conditions. Should there be no more benefits remaining on the medical aid they will not authorise another stay in treatment. These benefits reset each calendar year. This means that if you have used your benefits in 2020, they will be available to use again on the 1st of January, 2021.

If you do not stay for the full duration of treatment: As a rule, medical aids pay out per day, so if you stay in treatment for half the time, they will only cover half the fees. Again this varies between schemes and options. A medical aid may refuse to pay entirely if treatment is not completed. This is one of the many reasons it is recommended that you stay in treatment for the full amount of time.

Some general advice regarding medical aid and treatment

First and foremost, the best advice when it comes to medical aids is to be honest. We have seen many people denied benefits because they did not declare their addiction or alcoholism as a pre-existing condition. This is especially true if you have been in treatment before, but also applies if you have ever spoken to a doctor or received advice from a doctor regarding your addiction. This is especially important when first joining a medical aid, as it will have an impact on waiting periods and therefore the benefits available to you. It may seem awkward but keep in mind- everything that happens between yourself and a medical aid or broker is confidential.
On the subject of confidentiality, what is claimed from your medical aid is privileged information. This information will not be passed on to anyone else who is not associated with the treatment team or the medical aid. Many people are concerned that this information will be common knowledge or easily accessible – it is not. The only exception is that the information may be accessible to other members on the medical aid plan.

How do I know what my medical aid will cover?

The easiest way to determine availability or value of funds is to do a pre-authorisation. This can be done prior to admission. This is obligation free, if pre-authorisation is obtained and the person is never admitted, the benefits will still be available to use at any point in the future.

Contact us to find out more about how your medical aid can assist you in getting treatment, we work with most approved medical aids.

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Stories of Recovery

  • The encouragement, love and support from the team at Crossroads allowed me to eventually see that I was worth something - that my life could be turned around and that I could accomplish the things that had long been a forgotten dream.
    Oliver VG
    Read more
  • On the last day of my stint at Crossroads I could only express gratitude towards all who works there. A wise councillor once commented on my question when one is ready for rehab by explaining that when one is ready for rehab, rehab is ready for you.
    Johan B
    Read more
  • I was lost and my soul was broken until I ended up at Crossroads and was introduced to the Twelve Steps. With the help of their excellent staff and amazing support I have recently been clean for 18 months, I could not have done it without them!
    Carla S
    Read more
  • "Just for today I am more than three years in recovery. I have Cross Roads to thank for this wonderful gift. Cross Roads helped me to set a firm foundation in my recovery on which I can continue to build."
    Angelique J
    Read more
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What is Drug Addiction?

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What is Drug Addiction?

16 September, 2020Articles, News

What is Addiction?

Drug addiction is a disease that affects your brain and behaviour. When you are addicted to drugs, you can’t resist the urge to use them, no matter how much harm the drugs may cause.

Drug addiction isn’t about just heroin, cocaine, or other illegal drugs. You can get addicted to alcohol, nicotine, opioid painkillers, and other legal substances.

At first, you may choose to take a drug because you like the way it makes you feel. You may think you can control how much and how often you use it, but over time, drugs change how your brain works. These physical changes can last a long time. They make you lose self-control and can lead to harmful behaviours.

Addiction vs. Abuse

Drug abuse is when you use legal or illegal substances in ways you shouldn’t. You might take more than the regular dose of pills or use someone else’s prescription. You may abuse drugs to feel good, ease stress, or avoid reality, however, usually, you’re able to change your unhealthy habits or stop using altogether.

Addiction is when you can’t stop. You cannot stop even when it puts your health in danger, nor when it causes financial, emotional, and other problems for you or your loved ones. That urge to get and use drugs can fill up every minute of the day, even if you want to quit.

Effect on Your Brain

Your brain is wired to make you want to repeat experiences that make you feel good. This means that you are motivated to do them again and again.
The drugs that may be addictive, target your brain’s reward system. They flood your brain with a chemical called dopamine. Dopamine triggers a feeling of intense pleasure. This leads you to keep taking the drug to chase that same feeling of pleasure or high.

Over time, your brain gets used to the extra dopamine. You might need to take more of the drug to get the same good feeling. Other things you enjoyed, such as food and hanging out with family, may give you less pleasure. When you use drugs for a long time, it can cause changes in other brain chemical systems and circuits as well.

They can hurt your:
– Judgment
– Decision making
– Memory
– Ability to learn

Together, these brain changes can drive you to seek out and take drugs in ways that are beyond your control.

Who’s Most Likely to Become Addicted?

Each person’s body and the brain is different. People also react differently to drugs. Some love the feeling the first time they try it and want more. Others hate it and never try again.

Not everyone who uses drugs becomes addicted, but it can happen to anyone and at any age. Some things may raise your chances of addiction, including:
– Family history. Your genes are responsible for about half of your odds. If your parents or siblings have problems with alcohol or drugs, you’re more likely to as well. Women and men are equally likely to become addicted.
– Early drug use. Children’s brains are still growing, and drug use can change that. Taking drugs at an early age may make you more prone to addiction when you get older.
– Mental disorders. If you’re depressed, have trouble paying attention, or worry constantly, you have a higher chance of addiction. You may turn to drugs as a way to try to feel better.
– Troubled relationships. If you grew up with family troubles and aren’t close to your parents or siblings, it may raise your chances of addiction.

Signs of Addiction

  • You may have one or more of these warning signs:
    • An urge to use the drug every day, or many times a day.
    • You take more drugs than you want to, and for longer than you thought you would.
    • You always have the drug with you, and you buy it even if you can’t afford it.
    • You keep using drugs even if it causes you trouble at work or makes you lash out at family and friends.
    • You spend more time alone.
    • You don’t take care of yourself nor care about your physical appearance.
    • You steal, lie, or do dangerous things such as driving whilst high or have unsafe sex.
    • You spend most of your time getting, using, or recovering from the effects of the drug.
    • You feel sick when you try to quit.

When to Get Help

If your drug use is out of control or causing problems, talk to your doctor.
Getting better from drug addiction can take time. There’s no cure, but treatment can help you stop using drugs and stay drug-free.

Your treatment may include counselling, medicine, or both. Talk to your doctor to figure out the best plan for you.

No Obligation Addiction Assessment

Book a No Obligation Confidential Assessment at your nearest Treatment Centre Today.

Johannesburg Admissions: +27 74 895 1043
Pretoria Admissions: +27 82 653 3311
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Stories of Recovery

  • The encouragement, love and support from the team at Crossroads allowed me to eventually see that I was worth something - that my life could be turned around and that I could accomplish the things that had long been a forgotten dream.
    Oliver VG
    Read more
  • On the last day of my stint at Crossroads I could only express gratitude towards all who works there. A wise councillor once commented on my question when one is ready for rehab by explaining that when one is ready for rehab, rehab is ready for you.
    Johan B
    Read more
  • I was lost and my soul was broken until I ended up at Crossroads and was introduced to the Twelve Steps. With the help of their excellent staff and amazing support I have recently been clean for 18 months, I could not have done it without them!
    Carla S
    Read more
  • "Just for today I am more than three years in recovery. I have Cross Roads to thank for this wonderful gift. Cross Roads helped me to set a firm foundation in my recovery on which I can continue to build."
    Angelique J
    Read more
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Sleep and Substance Use

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Home / Posts tagged "Rehab Pretoria" (Page 8)

Sleep and Substance Use

11 September, 2020Articles, News

“Sleep is the single most effective thing we can do to reset our brain and body health each day — Mother Nature’s best effort yet at contra-death.”

― Matthew Walker, author of “Why We Sleep: Unlocking the Power of Sleep and Dreams”.

Why is Sufficient Sleep Necessary to our Functioning :

Sleep is a physiological necessity, so much so, that we spend nearly one third of our lives sleeping. Getting sufficient, quality sleep, is as important to our survival as food and water. Research has shown that chronic lack of sleep, or poor quality sleep, increases the risk of health problems including high blood pressure, cardiovascular disease, insulin resistance, Type 2 diabetes, obesity, depression and other mental health disorders. Poor sleep quality reduces productivity and increases irritability. Without sufficient sleep you are unable to form or maintain the pathways in your brain which are responsible for learning and the creation of new memories, thus making it harder to concentrate and respond to situations effectively. Lethargy, dullness of mind, forgetfulness, feelings of not being able to cope, or even grumpiness are all signs of insufficient, poor quality sleep.

Substance Use and Sleep :

Sleep and substance use is frequently bidirectional in nature- substance use causes problems with sleep and sleeping; but insomnia and insufficient sleep may also be a factor in substance use and addiction. Different substances affect sleep in different ways, for example, alcohol increases slow wave sleep and suppresses rapid eye movement (REM) sleep. During periods of acute withdrawal, sleep latency (the time taken to fall asleep) is increased and the total time spent asleep is decreased. Similarly, opiates, despite being sedatives, interrupt sleep by increasing wakefulness and decreasing total sleep time, slow wave sleep, and REM sleep. Furthermore, opioids and opiates are known to affect the brain mechanism that controls breathing. This can potentially create sleep apnoea events where individuals experience pauses in their breathing, resulting in snoring or gasping, a dry mouth and even a headache in the morning. In terms of cannabis, chronic users develop a tolerance towards its’ sleep-enhancing effects. During withdrawal and periods of abstinence from cannabis, unusual dreams and poor sleep quality is common. This poor quality sleep together with insomnia has been shown to be predictive of a relapse amongst users of cannabis, with over 40 % of participants in one study reporting prolonged periods of insomnia and 10 % of those who relapsed, cited insomnia as a factor in their relapse. Insomnia experienced during withdrawal from substances, frequently fuels craving.

Sleep as a Predictive Factor in Relapse :

Poor quality sleep is a predictive factor in relapse. Studies have shown that sleep disturbances are reported by individuals for some drugs, long after they have quit taking them and after other withdrawal symptoms have subsided. For example, disruptions in REM sleep can sometimes persist for 1 to 3 years amongst alcoholics who have achieved sobriety. The REM stage of sleep is believed to be associated with mood regulation and the consolidation of memories. Disturbed sleep appears to be a significant predictor of relapse in alcoholics even after controlling other factors, such as depression. Further, because sleep is important in memory consolidation, sleep dysfunction may interfere with the learning of new associations and skills needed for successful recovery from alcoholism.

Although this is a relatively new area of study and much of the research that has been done in this field has been done on small groups, there can be no doubt that in order to successfully recover from addiction, we need to be mindful of practising good sleep hygiene.

Practising Good Sleep Hygiene :

Here are some tips that may assist you in practising good sleep hygiene.

  1. Get sufficient exposure to daylight : light, especially sunlight, is one of the key drivers of circadian rhythms (internal processes that regulates the sleep-wake cycle, repeating roughly every 24 hours) that can encourage quality sleep.
  2. Avoid caffeine and nicotine and other chemicals that interfere with sleep.
  3. Exercise early : exercise stimulates the body to secrete the stress hormone cortisol, which causes the brain to become alert, so although exercise can help you fall asleep faster and sleep more soundly, it needs to be done at the correct time. Ideally, exercising should be completed at least three hours before your intended bed time. It is best to exercise earlier in the day.
  4. Unplug from electronics: maintain a 30-60 minute pre-bed time that is free of all devices such as mobile phones, tablets, laptops and televisions. Not only do these devices cause our brains to be stimulated, they also generate blue light that may decrease melatonin (the hormone associated with sleep produced by the pineal gland. It helps you fall asleep by calming the body before bed ).
  5. Follow a consistent routine at bedtime: follow the same steps each night, including things like putting on your pyjamas and brushing your teeth. Your brain picks up on the little cues that are telling it – it is time for sleep.
  6. Budget 30 minutes for winding down prior to sleep: use calming aids such as soft music, light stretching, reading, meditation or prayer. Try not to make falling asleep your goal, instead focus on relaxation. Meditation, mindfulness, breathing exercises and other relaxation techniques may put you in the correct mindset for bed.
  7. Don’t Toss and Turn: try to maintain a healthy mental connection between being in bed and actually being asleep. If after 20 minutes you haven’t managed to fall asleep, get up and stretch, read, or do something else calming in low light before attempting to fall asleep again.
  8. Don’t Dine Late: Eating dinner late, especially if it’s a big, heavy, or spicy meal, can mean you’re still digesting when it’s time for bed. If you need to snack before bedtime, the snack should be a light one.

If you are a recovering addict or alcoholic and you are experiencing persistent problems with sleep, do not ignore them. Keep a sleep journal, speak to your sponsor or counsellor and seek assistance in improving your quality of sleep.

RESOURCES :

Sleep Hygiene :

https://www.sleepfoundation.org/articles/sleep-hygiene

Differential Effects of Addictive Drugs on Sleep and Sleep Stages :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688758/

Sleep Disorders in Substance Abusers- How Common Are They? :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766287/

Connections between Sleep and Substance Use Disorders :

https://www.drugabuse.gov/about-nida/noras-blog/2020/03/connections-between-sleep-substance-use-disorders

Drugs, sleep, and the addicted brain :

https://www.nature.com/articles/s41386-019-0465-x

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Johannesburg Admissions: +27 74 895 1043
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Stories of Recovery

  • The encouragement, love and support from the team at Crossroads allowed me to eventually see that I was worth something - that my life could be turned around and that I could accomplish the things that had long been a forgotten dream.
    Oliver VG
    Read more
  • On the last day of my stint at Crossroads I could only express gratitude towards all who works there. A wise councillor once commented on my question when one is ready for rehab by explaining that when one is ready for rehab, rehab is ready for you.
    Johan B
    Read more
  • I was lost and my soul was broken until I ended up at Crossroads and was introduced to the Twelve Steps. With the help of their excellent staff and amazing support I have recently been clean for 18 months, I could not have done it without them!
    Carla S
    Read more
  • "Just for today I am more than three years in recovery. I have Cross Roads to thank for this wonderful gift. Cross Roads helped me to set a firm foundation in my recovery on which I can continue to build."
    Angelique J
    Read more
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Drug Use and Pregnancy

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Home / Posts tagged "Rehab Pretoria" (Page 8)

Drug Use and Pregnancy

09 September, 2020Articles, News

As an expectant mother, you want your baby to be as healthy as possible. Remember that most of what you consume is passed along to your growing baby. While some things are good for your baby, others can be harmful. Alcohol and illegal drugs are known to be particularly dangerous for a developing baby. Any amount of these substances is considered unsafe during pregnancy. You should avoid them altogether while you’re pregnant. Quitting before you get pregnant is ideal, but stopping drug or alcohol use at any point during pregnancy will benefit your baby.

How Does Drug Use During Pregnancy Affect the Baby?

You and your baby are connected by the placenta and umbilical cord. Nearly everything that enters your body will be shared with your baby. This means that any drug you use will also affect your baby. A foetus is very sensitive to drugs and can’t eliminate drugs as effectively as you can. Consequently, the chemicals can build up to extremely high levels in the baby’s system and cause permanent damage.

Taking drugs during pregnancy also increases the chance of birth defects, premature babies, underweight babies, and stillborn births. Exposure to drugs such as marijuana — also called weed, ganja, dope, or pot — and alcohol before birth has been proven to cause behavioural problems in early childhood. These drugs can also affect the child’s memory and attentiveness. In addition, some findings show that babies born to women who use cocaine, alcohol, or tobacco when they are pregnant may have brain structure changes that persist into early adolescence.

The risks associated with drug use during pregnancy depend on various factors, including:

  • the type of drug used
  • the point at which the drug was used
  • the number of times the drug was used

In general, however, using drugs during pregnancy can result in the following:

  • miscarriage
  • stillbirth
  • small size
  • low birth weight
  • premature birth
  • birth defects
  • sudden infant death syndrome
  • drug dependency in the baby

Here are some of the specific consequences of drug use during pregnancy:

  • Low birth weight places an infant at a higher risk for illness, intellectual disability, and even death.
  • Premature birth increases the risk of lung, eye, and learning problems in the infant.
  • Birth defects that often occur due to drug use include seizure, stroke, and intellectual and learning disabilities.
  • Foetuses can become dependent on the drug(s) the mother is using and may experience withdrawal symptoms after delivery.

Drug use during early pregnancy can affect the developing organs and limbs of the foetus. Even one episode of drug use during this period can affect the development of your child. In most cases, it results in a birth defect or miscarriage. Drug use later in pregnancy can affect the development of your baby’s central nervous system. After pregnancy, many drugs can pass through breast milk and harm the baby.

Using any type of illegal drug during pregnancy can have a detrimental effect on your child. Here is some information on the most commonly used drugs and how they can affect a developing baby.

Marijuana

To get the full effect of marijuana, smokers need to inhale deeply and hold the smoke in their lungs for as long as possible. There are many harmful gases in marijuana smoke that can be passed along to your baby, increasing the risk for complications. Smoking marijuana during pregnancy may increase the chances that your baby will have a bowel movement while inside the womb, which can cause early onset of labour and foetal distress. Marijuana use can also result in poor growth, behavioural problems, and breathing problems.

Marijuana use should also be avoided while breast-feeding, as the drug can easily be transmitted to the baby through breast milk.

Cocaine

Cocaine use during pregnancy increases the risk of miscarriage and stillbirth. It can also cause premature rupture of membranes (water breaks early), early separation of the placenta, and preterm labour. A baby exposed to cocaine is at a higher risk for:

  • stroke
  • poor growth
  • feeding problems
  • deformed limbs
  • brain damage
  • reproductive or urinary system abnormalities
  • sudden infant death syndrome
  • long-term behavioural problems

After pregnancy, cocaine can be transmitted to the baby through breast milk, so it shouldn’t be used while breast-feeding.

Opiates (Narcotics)

Opiates, also known as narcotics, include heroin and methadone. Women who use narcotics during pregnancy are at increased risk for preterm labour and delivery. They are also more likely to deliver a stillborn baby or a baby with growth problems. Babies exposed to narcotics in utero are at increased risk for neonatal death.

Heroin

If you use heroin during pregnancy, your baby may be born addicted to the drug. They may experience a severe, life-threatening withdrawal syndrome after delivery. This condition is characterized by the following symptoms:

  • high-pitched crying
  • poor feeding
  • tremors
  • irritability
  • sneezing
  • sweating
  • vomiting
  • diarrhea
  • seizures

Your baby will need special care and medication to treat their withdrawals.

If you share needles, you should be tested for HIV and hepatitis. These infections can also cause complications in your baby.

Like cocaine and marijuana, heroin shouldn’t be used while breast-feeding.

Methadone

If you can quit using opiates altogether, it will be best for you and your baby. However, switching to methadone is better than continued heroin use. Methadone is associated with better pregnancy outcomes than heroin, but babies can still experience the narcotic withdrawal syndrome. Additionally, they may still be at an increased risk for sudden infant death syndrome (SIDS). For these reasons, it’s best to avoid using methadone during pregnancy. Methadone use of 20 milligrams or less per day is compatible with breast-feeding.

Amphetamines

If you use stimulants, such as crystal methamphetamine (speed), then you are at increased risk for the following problems:

  • early placental separation
  • delivery of a baby with growth problems
  • death of the foetus in utero

Amphetamines shouldn’t be used if you’re breast-feeding.

RESOURCES

https://www.healthline.com/health/pregnancy/alcohol-drugs

https://www.webmd.com/baby/drug-use-and-pregnancy

No Obligation Addiction Assessment

Book a No Obligation Confidential Assessment at your nearest Treatment Centre Today.

Johannesburg Admissions: +27 74 895 1043
Pretoria Admissions: +27 82 653 3311
Close

Stories of Recovery

  • The encouragement, love and support from the team at Crossroads allowed me to eventually see that I was worth something - that my life could be turned around and that I could accomplish the things that had long been a forgotten dream.
    Oliver VG
    Read more
  • On the last day of my stint at Crossroads I could only express gratitude towards all who works there. A wise councillor once commented on my question when one is ready for rehab by explaining that when one is ready for rehab, rehab is ready for you.
    Johan B
    Read more
  • I was lost and my soul was broken until I ended up at Crossroads and was introduced to the Twelve Steps. With the help of their excellent staff and amazing support I have recently been clean for 18 months, I could not have done it without them!
    Carla S
    Read more
  • "Just for today I am more than three years in recovery. I have Cross Roads to thank for this wonderful gift. Cross Roads helped me to set a firm foundation in my recovery on which I can continue to build."
    Angelique J
    Read more
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