Pre-Authorised Hospital Admission Red Tape

    The rigmarole involved with pre-authorised hospital admission is well worth the red tape.

    It provides members of Hospital Plans with all relevant facts and figures appertaining to their stays in a hospital.

    Medical aid Hospital Plans will cover all costs of surgery, treatments and hospital stay, depending on the option selected.

    Selfmed, for example, will cover all costs of hospital procedures, theatres, medication and disposables, as well as the actual cost of hospital stays.

     

    Pre-Authorised Hospital AdmissionThese, however, are subject to obtaining hospital admission pre-approvals and conditions as set out by the Hospital Plan.

    Pre-authorised hospital admissions allow policyholders to determine exactly what costs and what, if any, additional expenses they will have to subsidise.

    Depending on the hospital plan selected, several other medical

    procedures can be covered. These include:

    • Gastro-intestinal endoscopies
    • Laser tonsillectomies
    • CT and MRI scans
    • Blood transfusions

     

    These benefits can be subject to change, so it is advisable always to obtain pre-approval.

     

    What is The Red Tape Involved With Pre-Authorised Hospital Admission?

    • Apply at least 48 hours before¬†going to a hospital
    • Supply membership number
    • Supply name, date of birth of member or beneficiary
    • Provide all relevant contact details
    • State reason for and date of admission
    • Obtain all information regarding tariffs that are covered
    • Provide name and number of medical practitioner performing the operation

     

    What you should know

    Failure to obtain pre-authorised hospital admission from medical schemes will make policyholders solely responsible for covering the cost of their hospital procedures and care.

    The onus is thus solely on members to undertake the rigmarole of red tape to ensure they receive the full benefits of their Hospital Plan.

    However, it is also important to remember that pre-authorised hospital admission does not necessarily mean the costs will have full cover.

    Payments are dependent on the terms and conditions of individual Hospital Plans.

    It is therefore of the utmost importance that consumers purchase Hospital Plans offering the best benefits. These are not the cheapest plans available on the market, but they are the best value for money.

    Carefully scrutinise the fine print of the Hospital Plan before making an educated decision.

    Points to remember

    Be aware of the following terms and conditions in the selected Hospital Plan:

    Waiting periods, limits, exclusions, benefits and co-payments

    Fully understand all clauses of the contract, particularly those involving exclusions of operations and items not covered by the medical scheme

    Check amounts available in savings benefits

    So always try to use the network of service providers designated by the Hospital Plan to avoid expected co-payments

    Always ensure that you pay premiums on time to enjoy the privileges of qualified membership

     

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