Pre-authorisation is our way of making sure certain healthcare services and treatments are covered before you receive them. By getting approval in advance, you can have peace of mind knowing what’s covered, avoid unexpected costs, and ensure a smooth claims process.
Whether for hospital admissions, specialised procedures, or ongoing treatments, our team is here to guide you through every step of the pre-authorisation process.
Hospital Pre-Authorisation
Please adhere to the following guidelines for hospital pre-authorisation:
- 72 hours before a planned procedure
- Within 48 hours of an emergency procedure.
Pre-Authorisation for other Treatments
Apart from hospital admission, certain treatments require pre-authorisation before they are received. Members are encouraged to review their plans for such treatments. If in doubt, contact the Scheme at authorisations@sizwehosmed.co.za or 086 010 1176.
Failure to get Pre-Authorisation
Failure to get pre-authorisation may result in co-payment or claim rejection.
What information do I need to get Pre-Authorisation
The following information is required for pre-authorisations:
- Main member’s membership number
- Patient/dependant code, name, and ID number
- Date of birth
- Doctor’s practice number
- Anaesthetist’s practice number
- Hospital name and practice number
- Date and duration of the admission
- Procedure codes
- ICD10 codes
