Pre-authorisation for Managed Care

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

How to contact us for pre-authorisation

Healthcare providers can contact us by telephone or email, using the contact details below, 48 hours before any planned admission or at the point of service.

In an emergency admission, providers should please call us within 24 hours of the admission to authorise the treatment.

Members should also contact us by telephone or email, using the contact details below, 72 hours before any planned admission or procedure.

In an emergency, members should please call us within 24-48 hours of admission or after the emergency treatment.

Information we need

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

Feedback on your request

We will let you know the outcome of your pre-authorisation request immediately if you call, and usually on the same day or within 48 hours when you request pre-authorisation by email. You will receive a pre-authorisation number as part of the email when we approve a request.

Please update us regularly on your hospital stay

You and your healthcare provider need to update us 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 our contact details below.

How to submit a claim

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