Pre-authorisations

Procedures and hospital admissions

For the Standard and Advanced Options hospital pre-authorisation must be obtained at least 48 hours before you go to hospital.

In the case of an emergency, pre-authorisation is required within 24 hours of the admission, or on the next working day after you were admitted.

The pre-authorisation process checks benefits availability and determines if a medical procedure is clinically required. The granting of pre-authorisation does not guarantee full payment of your claims.

When you need to obtain pre-authorisation, please ask your doctor for as much assistance as possible. It remains your responsibility to ensure that an authorisation number is obtained. Should this not be done, you will be liable for payment of the full account.

Pre-authorisation

  • 1
    Call: 0861 888 118

    Required information

    Membership number Patient's full name Patient's date of birth Hospital's practice number Doctor's practice number Admission hospital CPT4 number or tariff code Date of admission of procedure and length of stay ICD-10 code
  • 2
    If approved, you will revieve a pre-authorisation number (use this as reference)
  • 3
    Provide your doctor with the pre-authorisation number

Chronic medication pre-authorisations

A chronic condition is a disease that is persistent or otherwise long-lasting in its effects. The term chronic is often applied when the course of the disease lasts for more than three months.

Chronic conditions are subject to pre-authorisations by the Medicine Risk Management Department. Please review our Medicine Risk Management Programme.