Medical Aid Authorisations
GENERAL
Pre – authorisation for your hospital admission, specialised radiology or upcoming procedure is essential if not mandatory.
This will ensure that your hospital stay will be free from the added stress of unpaid hospital and doctors’ bills.
Pre – authorisation will allow you to understand exactly what will be covered and what not.
Failure to obtain the necessary authorisation can result in large co-payments or even the patient being liable for the entire bill.
Authorisations are procedure-specific and will not cover unrelated complaints or investigations while being admitted in hospital.
Please be aware that being admitted to hospital does not automatically imply that everything done and tests requested will be covered by your medical aid.
(eg – a patient admitted for chest pain will be covered for the angiogram as well as related issues and complications arising from that, however e.g. should he or she also want their lower back problem, varicose veins or headaches sorted out – the tests and procedures related to this may not be covered).
HOW TO GET PRE-AUTHORISATION
It is the primary responsibility of the patient to make sure that pre-authorisation is obtained before being admitted.
The Pre-Authorisation Office is situated on the 5th floor of Busamed Gateway Private Hospital ( Suite 501) and our experienced staff will gladly assist you.
Office hours are from Monday to Friday from 7-30am to 16-30.
Admissions after hours and over weekends will be handled by the hospital reception staff on the ground floor or in the Emergency Unit on the lower ground level.
Motivation letters for certain procedures or radiology requiring special motivations will be done by your doctor.
PATIENTS ON HOSPITAL PLAN
Hospital plans underwritten by medical aid schemes will normally cover your admission to hospital and in-patient treatment, but will not cover your day-to-day doctor visits and related tests etc.
Its important to remember that it is a hospital-cover and intended for conditions that can only be treated in hospital.
Being admitted for tests only, or day-to-day visits that don’t normally require a hospital stay, is not permitted and can lead to your admission not being covered by your medical aid.
IN HOSPITAL PATIENTS
Patients admitted for angiograms (the pre-authorisation was for the angiogram) requiring bypass surgery subsequent to the results of the angiogram, a new pre-authorisation for the new procedure will be obtained by the hospital in cooperation with the attending doctor