POLMED medical aid rehab cover at Houghton House

POLMED provides benefits for both substance use rehabilitation and psychiatric treatment, funded under Prescribed Minimum Benefits (PMBs) and subject to managed care rules. With the correct pre-authorisation in place, members can access cover for the following:

• In-hospital medical detox when clinically required
• Inpatient rehabilitation for substance use disorders
• Inpatient psychiatric care, limited to 21 days per beneficiary per year
• Medication management according to scheme rules
• Follow-up treatment and consultations, where approved

Houghton House works directly with POLMED to ensure these benefits are correctly accessed and to help you receive treatment without delays or unexpected costs.

POLMED uses designated service providers (DSPs) for certain benefits, including mental health and rehabilitation. In the POLMED provider network search, Houghton House is currently listed as “out of network” for both mental health and rehabilitation.

This would normally mean that members could face a co-payment or penalty if choosing Houghton House instead of a DSP facility. However, Houghton House takes proactive steps to protect patients:

• NHN membership: As a member of the National Hospital Network (NHN), Houghton House charges POLMED scheme rates for all approved admissions.
• Penalty waivers: In most cases, Houghton House waives any co-payment or penalty, ensuring that your treatment remains fully covered once authorised.
• Admin support: All pre-authorisations and scheme communications are handled by our team, so you don’t have to worry about navigating the rules.

This means that even though Houghton House is not listed as a POLMED DSP, patients don’t incur extra costs beyond the standard admission fee.

No, you do not need a referral from a GP or specialist to access substance use treatment or psychiatric care through POLMED. You can contact Houghton House directly. We begin with a confidential assessment conducted by one of our registered mental health professionals.

We submit the necessary documents and motivation to POLMED for pre-authorisation. Our team handles all paperwork and clinical coding, so there’s no administrative burden on you or your family.

No. If your treatment at Houghton House is pre-authorised by POLMED, you should not face any unexpected bills.

Although Houghton House is listed as an out-of-network provider, patients generally do not incur co-payments because:

• As a member of the National Hospital Network (NHN), Houghton House charges scheme rates for all approved admissions
• In most cases, Houghton House waives any penalties associated with choosing an out-of-network provider

This means that once your admission is authorised, your treatment is typically covered in full by POLMED. Any potential shortfalls will be clearly explained before admission.

Before admission, POLMED requires pre-authorisation for all mental health and rehabilitation services. This step is essential to activate your benefits.

The process may sound complicated, but at Houghton House you don’t need to worry:

• Our admissions team handles all pre-authorisation requests on your behalf
• We liaise directly with POLMED to confirm your benefits and secure approval
• You’ll be kept informed of any clinical requirements or limits tied to your cover

This ensures a seamless process, so you can focus fully on your recovery.

POLMED applies waiting periods to new members in certain cases:

• General waiting period (usually three months) may apply for all new joiners
• Condition-specific waiting periods (usually 12 months) may apply if you join with a pre-existing condition
• If you were previously covered by another registered medical scheme and switch to POLMED without a significant break, waiting periods may be reduced or waived

PMB-related care (including treatment for substance use and specific psychiatric conditions) may still be covered during waiting periods. Our admissions team can help you check whether a waiting period applies to your membership and advise you upfront if any waiting periods affect your admission or cover.

At Houghton House, we combine 30 years of experience with a compassionate, professional approach to recovery. As one of South Africa’s leading addiction and psychiatric treatment centres, we provide comprehensive care that addresses both substance use and co-occurring mental health conditions.

We offer:

• Full-spectrum treatment, from medical detox and inpatient rehab to outpatient care and relapse prevention
• A multidisciplinary team of psychiatrists, psychologists, medical doctors, social workers, and addiction counselors working together for your recovery
• Tailored care plans with treatment personalised to meet your unique needs and circumstances
• A comfortable environment in safe, supportive, and discreet facilities designed to promote healing and wellbeing
• Comprehensive dual-diagnosis care for patients struggling with addiction as well as mental health conditions

Our dedicated case management team works closely with POLMED throughout your stay, ensuring all treatment is preauthorised, billed correctly, and reported as required. From your first call to the final day of care, we aim to make the process simple, supportive, and fully transparent.

Choosing Houghton House means choosing a trusted partner in recovery, with proven expertise in guiding patients and families toward long-term healing.