We need the following information when you pre-authorise for a procedure
• Name and surname of the person having the procedure
• Membership number and dependent code
• The date of admission or procedure
• The diagnosis
• All proposed surgical procedures , diagnostic procedures or specialised radiology codes available ( ICD-10 , CPT , NRPL codes )
• The name of the facility where the procedure will take place
• The names and practice numbers of the healthcare professionals ( doctor , surgeon , specialist , etc .)
So how do I pre-authorise a procedure ?
• Call us on 0861 239 333 ( for BonCap ) or 0860 002 108 ( for all other options )
• Send an email to hospital @ bonitas . co . za
Once your pre-authorisation has been approved you will receive a confirmation letter . Please make sure that you read and fully understand what is outlined in this letter . Speak to your doctor or your medical scheme if you have any questions .
What about emergency admissions ? In the event of emergency treatment or admission to hospital , you must contact the call centre on the first working day after the incident . If you cannot
contact us , a family member or the hospital can do so on your behalf .
It is not always as easy as 1 , 2 , 3 At times there may be a delay in approving preauthorisation because of rules or clinical criteria , especially when we need extra information from your doctor to understand and authorise the visit . So make sure that you contact us with time to spare , just in case we need to ask a few questions or gather some clinical information .
Did you know ? Your doctor or the facility you are being admitted to , can do the authorisation on your behalf . Despite this , it remains your responsibility to ensure that the authorisation is completed and correct . If your doctor or facility pre-authorises your visit , make sure to check the details very carefully and to follow up with us if necessary .
Quotes vs pre-authorisation for procedures Bonitas advises members to not only obtain preauthorisation but to also ask for a detailed quote from the hospital and medical practitioner prior to being admitted to hospital ( if it ’ s not an emergency ). It means you can submit it to your medical aid ahead of the procedure to find out if co-payments will be required and if so , how much they are .
Bonitas Member Magazine Issue 2 | 2021
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