“Because Care Shouldn’t Be Confusing — or Costly.”
Every family’s journey is unique, and understanding the financial side of care helps you make choices that feel right for your child and your peace of mind. Understanding the cost of care helps families plan with confidence. We share clear information about treatment expenses so you can make choices that fit your family’s needs and values.
Medical Aid Coverage Explained
It’s crucial to understand what medical aid typically covers, as autism and many related treatments often fall outside standard benefits.
Autism & Chronic Benefits
Autism does not fall under any general medical aid benefit, nor are treatment or therapies covered under the Chronic benefit.
Common Tests & Day-to-Day Expenses
- Blood Tests: Typically covered from your day-to-day expenses.
- Stool/Urine Tests: General tests (e.g., for gastrointestinal issues, parasites) are paid via pathology benefits. More detailed tests may not be covered.
- Audiology, Dietetics, Genetic Counselling, Occupational Therapy, and Speech Therapy: Generally subject to day-to-day benefits.
Specialized Radiology
CT scans and MRI could be subjected to an annual overall limit per family.
Organic Acid Test (OAT) – A Detailed Look
The OAT provides a comprehensive metabolic snapshot, evaluating intestinal yeast and bacteria, vitamin and mineral levels, oxidative stress, and neurotransmitter levels. It also includes markers for oxalates, which can be highly correlated with many chronic illnesses.
Cost examples
- R2140 with Ampath
- R2300 with Pathcare
- R2300-R9000 through other medical companies (e.g., Great Plains Laboratories, which has a South African representative).
Understanding the Costs: Personal Experience
At the time of diagnosis, working for a Medical Aid company allowed me to afford the private route. Here are some examples of the costs incurred:
As evident from these examples, the costs can be substantial, even with medical aid, as these specialized tests are often not covered.
Chronic Conditions & Mental Health Benefits
If your child is diagnosed with another chronic condition, some medical aids might offer coverage. For instance, some cover ADD (Attention Deficit Disorder) up to 18 years of age, though this is usually limited to certain medications. It’s important to note that medical aids generally don’t cover ADHD. While most medical aids now include mental health benefits, it’s uncertain if anything related to Autism would be covered under these benefits.
Are All These Tests Necessary?
For many families, these extensive tests are simply unaffordable. When daily necessities are a struggle, the added burden of high medical costs becomes insurmountable. Government clinics, for example, typically focus on managing visible symptoms rather than running these specialised tests.
Families in poorer communities or low-income brackets face significant challenges in supporting a child on the Spectrum. While some medications might be available for free or at a lower cost at clinics, expenses for special diets, adaptive clothing (due to sensory issues), equipment, specialised schooling, and transport can quickly accumulate.
What about other expenses like extra lessons and therapies and schooling (Government schooling are not as expensive as Private schooling:
Financial Support and Grants
Navigating the financial landscape can be daunting, but there are resources and programs designed to offer assistance.
SASSA Care Dependency Grant
For those who qualify, you can apply for a grant from the SASSA (South African Social Security Agency). Visit your local SASSA office to complete the forms. The grant amount is equivalent to the Old People’s grant.
Qualifying Criteria
Application or renewal can also be done if your child attends a government-subsidized special needs school.
SARS Tax Rebate
If you are more financially well-off and pay taxes, you can apply for a rebate from SARS (South African Revenue Services). Visit your local SARS office to complete forms to claim back certain expenses related to your child’s Autism. This process can have its own complexities.
Other Funding Options:
Many parents create Trusts or NPOs (Non-profit organisations) to help manage day-to-day expenses. These often involve regular fundraisers or events like high teas with family and friends. Sometimes, you might find sponsors for promotional items like t-shirts, caps, and water bottles.
For those interested in starting an NPO, here is some more info:
- Model Constitution
- Application for NPC Company registration
- Application for NPO
- Frequently asked questions
Government Programmes
The Western Cape Government offers the Persons with Disabilities Programme, aimed at assisting individuals living with various disabilities.
Sheltered Workshops
These workshops provide supportive environments for individuals with disabilities to develop vocational skills and gain employment. Many attendees often come from the School of Skills programme offered through special needs schools.
- DWDE,
- The Living Link,
- Oasis Association,
- Western Cape Government site,
- Vasco Special Needs Centre,
- Spectrum Chef Academy (for those interested in cooking or becoming a chef)
- WCAPD.