Pre-authorisation

When to call for pre-authorisation

You need to obtain pre-authorisation for the following types of medical treatment.

This will ensure that we can assist you with your case, that you have access to quality care, and that your claims will be processed against the correct benefits:

• Hospitalisation (elective or planned and non-elective or emergency admissions)
• Same day procedures/minor planned surgeries
• Cancer treatment (inpatient and outpatient)
• Renal (kidney) dialysis (inpatient and outpatient)
• Specialised radiology (inpatient and outpatient, for example MRI and CT scans)
• Emergency evacuation (in-country and foreign)
• An appliance or a prosthesis
• Organ transplants
• Ambulance services (air and road)
• Maternity/delivery
• Optical (including spectacles)
• Dentistry (including specialised dentistry)

How to contact us for pre-authorisation

You or your healthcare provider can contact us by telephone or email, using the contact details below, at least 48 hours (2 business days) before any planned admission.

In the case of an emergency hospital admission, you should ask a friend or family member to contact us for pre-authorisation, within 24 working hours of the event, to ensure that your claims are paid. Or, if it is a weekend or public holiday, they should contact us on the next working day.

Information we need:

• Patient’s full name, membership number and date of birth
• Treating healthcare provider details: full name
• Hospital details: full name of hospital and practice number
• Reason for admission or emergency visit (medical and/or surgical condition)
• Date of admission and proposed date of the procedure
• Additional supporting documents where required
• When a procedure is done out of hospital, for example, MRI (out-patient radiology), you need to supply the healthcare provider’s name

Hospital and Scan Pre-authorisation Form

We will give you feedback on the same day

We will call or email your healthcare provider with a response on the same day, usually within an hour, for pre-authorisation requests made on Mondays to Saturdays. Your healthcare provider will receive a pre-authorisation number when we approve a request.

Please update us regularly on your hospital stay

You and your healthcare provider need to update Strategis regularly on the level of care that you need and the length of the hospital stay required. Payment will be made based on the pre-authorisation and available benefits.

Please see the Strategis pre-authorisation contact details below.

How to submit a claim

For more information on how to submit your claims, please click here.