FAQs

Q: “Who is responsible for obtaining hospital pre-authorization or authorization from a medical scheme for increased length of stay?”

The responsibility for obtaining pre-authorization for admission to a hospital for a specific diagnosis or procedure rests with the medical scheme member or patient. This authorization should be granted in writing with an authorization number being provided, the name of the person granting the authorization, the procedure or diagnosis and the approved length of stay.

In the event of an emergency admission the responsibility still rests with the patient or medical scheme member. If no pre-authorization is done, the patient will be admitted as a private patient. If a request for an increase in length of stay or level of care is denied by the medical scheme, the patient will also revert to a private account.

In many instances hospital staff do become involved in obtaining authorization, as a service to their clients, but the ultimate responsibility rests with the medical scheme member. It is imperative for all patients to sign the admission contract which states that the patient or guarantor remains responsible for any amount owed to the hospital or not reimbursed by the medical scheme.

view all FAQs