When a provider should call for pre-authorisation
The provider needs to obtain pre-authorisation for the following types of medical treatment. This is to ensure that all claims are processed against the correct benefits:
- Hospitalization (elective or planned and non-elective or emergency admissions)
- Optical
- Dentistry
- Radiology (inpatient and outpatient)
- Secondary out-patient treatments (Non-capitated services)
- Chronic medicines (Drug refill)
- Specialist consultations
- Ambulance services
- Antenatal and deliveries
- Surgical procedures
When a member should call for pre-authorisation
- When accessing care outside the network (for a covered service)
- When travelling out of the country of coverage (to confirm if the plan is covered outside the country in case of a refund)
- When going for an annual medical check-up