PRE-AUTHORISATION PROCESS

The pre-authorisation process ensures that the treatment or procedure is both necessary and appropriate. Except in emergencies, pre-authorisation must be obtained 48 hours before any hospital admission.

Pre-authorisation is required for the following, among others:

• all admissions to hospital
• outpatient treatment in a hospital, i.e. when you do not stay overnight at the hospital
• admission to a day hospital
• MRI or CT scans or radio-isotope studies
• Access to patient care programmes
• emergency ambulance transportation
• specialised and surgical dentistry in hospital
• visits to a specialist if you are on the Custom and Essential options
• additional consultations on the Classic and Classic Network options once your savings are depleted

Ask your healthcare practitioner for a full description of:

• the reason for admission to hospital or for the scan
• the associated medical diagnosis
• the planned procedure
• all the tariff and ICD-10 codes that the doctor intends to use
• Additional information required
• Your membership number
• Name and date of birth of the patient
• Date of admission
• Name and practice number of the provider
• Name and practice number of the hospital