Doing your pre-admission at the hospital
If you choose to visit one of our hospitals to complete your
pre-admission documentation, our receptionists will guide you through
the process and will assist you with the completion of the necessary
documentation, and can guide you on how to obtain authorisation from
your medical scheme for your hospital admission Please ensure that you
have your identity document and medical scheme membership card on hand.
Pre-admission procedures for medical scheme patients
Medical scheme members should note that all medical schemes require their members to obtain authorisation prior to hospital admission. Failing to obtain pre-authorisation from your medical scheme will mean that you personally will be liable for any shortfalls or penalties on your hospital bill.
To obtain authorisation, you will need to provide your medical scheme with a written medical diagnosis and code (ICD10 and CPT4) for your admission, as well as the practice number of the specialist under whose care you will be admitted. If you are scheduled for a procedure you will also require a description of the surgical procedure that will be performed as well as a code (CPT4).
The doctor admitting you to hospital should provide you with these details. Our receptionists will also require this information for your admission process.
We strongly recommend that you familiarise yourself with the rules of your medical scheme when obtaining pre-authorisation for your admission to hospital. 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.
As member of a medical scheme it is important to remember that it is your responsibility to ensure the following:
- You are aware of your benefits, co-payments, limits, exclusions and waiting periods
- You understand which items and procedures will not be covered by your medical scheme
- You are familiar with the amount available in your savings benefit
- You know of any preferred or designated service provider agreements and how it will affect the cover provided by your medical scheme if you choose to use the services of non-designated service providers
- You are a valid member and all your premiums are up to date
The hospitalisation costs for patients who belong to medical schemes are charged in accordance with Netcare tariffs. These tariffs are negotiated on an annual basis with the respective registered schemes. The hospital account is normally sent directly to the medical aid scheme for payment. You as member, however, remain responsible for this account, especially in cases where medical schemes fail to pay the account or only partially settle the account. Our pre-admission patient administrator will also advise you on the financial considerations with regard to your procedure and/or treatment.
Please ask our receptionists for any assistance you may require. Your cooperation in terms of obtaining authorisation and clarifying co-payment terms will ensure a quicker and more efficient admission process.