Admission Protocol – Medical Scheme Patients

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In order to obtain authorization from your medical scheme timeously:

  1. Our pre-admission administrator will guide you through the admission process
  2. Assistance with completion of documentation will be offered
  3. Your medical scheme requires pre-authorisation to be obtained 72 hours prior to the admission
  4. Failure to obtain pre-authorization will result in the member being liable for any shortfall or penalties instituted by the scheme
  5. In order for us to obtain pre-authorization on your behalf you will have to provide the following:
    • Written medical diagnosis and code [ICD-10] issued by your doctor
    • Written description of surgical procedure and code [CPT-4 or BHF] issued by your surgeon
    • Name and practice number of the doctor or specialist under whose care you will be admitted
    • Medical scheme membership card and proof of identification
  6. The pre-authorisation administrator will request authorisation on your behalf and inform you timeously of any deductibles, co-payments or shortfalls
  7. Payment in full of deductibles, co-payments or shortfalls must be made upon admission

We strongly recommend that you familiarize yourself with the rules of your medical scheme prior to admission. Please confirm with your medical scheme whether any levies, co-payments or exclusions may apply, and whether there are any aspects of your treatment for which you personally will be liable for payment.

  • Kindly also confirm your limits and benefits available – especially prosthesis limits for surgical procedures. A quote may be obtained from your surgeon for any prosthesis items estimated for use during the procedure.
  • All medical aid, as well as private accounts will remain the responsibility of the member. The member must ensure that the account was received by the medical aid within 30 days after discharge date and will remain the responsibility of the member to follow up until settled in full by medical aid.