UNDERSTANDING
PRE-AUTHORISATION
The pre-authorisation process ensures added value for all Bonitas members by making sure your claims are paid correctly and timeously . It also allows you to confirm your benefits before you undergo a specific hospital procedure .
What is pre-authorisation ? As daunting and complicated as the term pre-authorisation sounds , it ’ s actually quite simple to understand . All procedures that take place in a hospital must be pre-authorised . It is essentially an agreement between the medical aid and the hospital indicating a willingness to pay for costs associated with the visit . But , even if you do have pre-authorisation , your medical aid is not promising to cover 100 % of the costs . You are still responsible for your share of the costs including any co-payments . All pre-authorisation requests are evaluated against the Fund Rules and clinical funding policies .
When do I need to pre-authorise ? You must apply for a Pre-Authorisation Reference number ( PAR ) as soon as a visit or admission to a hospital or if a CT scan , MRI scan or radio-isotope study is planned . It is best to do this as early as possible as your medical aid might request additional documentation .
You will also need pre-authorisation for :
• Renal clinic admissions for dialysis
• Procedures in doctor ’ s rooms instead of hospitalisation
• Physical rehabilitation care in rehabilitation facilities
• Drug and alcohol rehabilitation care in specific facilities
• Hospice admissions
• Oxygen therapy at home
• All specialised radiology
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Bonitas Member Magazine Issue 2 | 2021