Bonitas Member Magazine B-Living Issue 2_2019 | Page 15

3. Make sure you provide all information required for pre-authorisation correctly: • Have your correct membership number and the details of the member for whom the request is • The date you are going into hospital and the date of the treatment or procedure • The name of the doctor who will be treating the member, their telephone number and practice number • The name of the hospital where you will receive treatment, their telephone number and practice number • The relevant procedure and diagnosis (ICD-10) codes for the treatment (ask your doctor for these). Pre-authorisation requests may be declined if: • The procedure or treatment is not covered by your plan as specified in the Scheme Rules • The procedure or treatment is not in line with the clinical and medical treatment standards for your condition • The information required for pre-authorisation is not included • Your Bonitas membership is inactive. If the medical procedure is approved, you will receive a pre-authorisation number and this will also outline the approved length of your hospital stay and the status of all codes. However remember that pre-authorisation is not a commitment by the Fund to the full amount. 4. Gap cover If you have Gap Cover, notify them of the co-payment required prior to being admitted to hospital as there are limits to the amount they will pay. Ensuring you are covered 1. Make sure you get a quote Medical aid members are advised to not only obtain pre-authorisation but also a quote from the hospital and medical practitioners prior to being admitted to hospital (if it’s not an emergency). Submit this to your medical aid to find out if there are any co-payments and if so, how much they are. 2. Find a hospital on your medical fund’s preferred network in order to ensure maximum payment What about emergencies? Emergencies must be pre-authorised within 48 hours of going into hospital or on the first working day after a weekend or public holiday. If you don’t get pre-authorisation, your account won’t be paid by the Scheme. The most important thing to find out, prior to being admitted, is what your medical aid will pay and what payment you are responsible for. It will save a great deal of stress when you are recovering from surgery. For hospital pre-authorisation: Call: 0860 002 108 Email: [email protected] Page 14