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What is Hospital PRE-AUTHORISATION?
Pre-authorisation is a process where a member applies to the Sc heme for approval of an operation or treatment that needs hospitalisation before being admitted to hospital. The pre-authorisation process considers the clinical need and importance of the operation according to the Scheme’s clinical rules before you are admitted to hospital. It also helps confirm if there are benefits available.
Why is it important to pre-authorise?
It is important for all members to confirm their benefits for hospital visits before being admitted, so that the Scheme can confirm the cover for the operation and for the claims to be paid from the correct benefit. When you receive pre-authorisation, this does not mean the operation will be paid for in full. This is a confirmation that you have received approval to have it done and the scheme will pay for the procedure according to the scheme tariff and available benefits.
Providers often charge fees that are higher than the scheme tariff and it is highlighted that pre-authorisation does not mean that the costs relating thereto will be paid in full.
We strongly recommend that, before you go for the procedure, you obtain a quotation from the doctor and other service providers such as anaesthetists. Submit the quotation to the scheme and request details of how much shall be covered by the scheme.
If you need to stay in hospital longer or have more than one operation, you will need to ask for extra authorisation. No extra benefits will be covered or paid for unless a longer stay or more than one operation are authorised by the Scheme.
How to pre-authorise a hospital admission or a procedure?
Whenever your doctor plans to admit you into hospital, you should tell us at least 48-hours before you are admitted into hospital. In case you are admitted in an emergency, you or a family member must get authorisation within 24-hours or on the first working day after the emergency
Getting your hospital pre-authorisation number
STEP 1: Make sure you have the following information with you
- • Glencore Medical Scheme membership number
- Name and contact details of the principal member
- Name and practice number of the doctor doing
- the operation
- Name and practice number of hospital where
- you are going to be admitted
- Date and time of admission
- ICD-10 code for diagnosis
- CPT-4 code/s for the procedure
STEP 2: Obtain the hospital pre-authorisation number
Contact us on 0860 00 21 41 or e-mail medicalscheme.authorisations@glencore.co.za for pre-authorisation, at least 48-hours before you are admitted into hospital. We will give you an authorisation number.
Please make sure the authorisation number is given to the doctor doing the operation and to the hospital where you are being admitted. Ask the doctor to include the authorisation number when they submit a claim.
If your admission is not approved before doing the operation and it is not an emergency, you can apply to the Scheme to ask them to reconsider. If your authorisation is declined, we will not pay for the costs related to your admission therefore you will have to pay for the operation.