Obtaining authorisation for your hospital admission can be a dreaded procedure. However with the correct guidance and information it should not be.

Once a member / beneficiary knows of a planned hospital admission, the healthcare provider (doctor), must provide you with the following information:

  • Healthcare provider practice details
  • Hospital information
  • Applicable ICD 10 codes
  • Applicable tariff codes
  • Date of admission
  • Estimated length of stay
  • Time of admission

With this information on hand, the pre authorisation from the Medical Scheme can be obtained at least 3 days prior to the planned admission.

A member / beneficiary must however remember that a Medical Scheme’s cover relating to the hospital admission, are determined by the member’s plan choice and the Scheme’s rules regarding the cover for the treatment / procedure. Set limits may and co-payments may apply.

*Our team make sure that all parties are in sync all of the time.  This prevents expensive co-payments and make sure you stay within your Scheme’s limits.

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