Why do we need pre-authorisation?

We ask you in many instances, before accessing a benefit, to call us for authorisation prior to a planned healthcare event. This could be a hospital stay, a procedure performed in a doctor’s room, the purchase of medical appliances or other healthcare services.

Why do you need to get authorisation?

  • To prepare us for your healthcare event so we can structure upcoming payments and manage protocols if necessary.
  • To inform you about available benefits for the healthcare service you are about to purchase.
  • To be able to help you understand what will and what won’t be paid by the Scheme and, if necessary, to assist you in negotiating rates with your provider.
  • To ensure that only clinically necessary and cost-effective services are funded.

Important facts to understand

  • Authorisation does not guarantee payment of all costs that you might incur – please speak to us to understand what part of your authorised service is funded.
  • The payment of healthcare services is subject to the Scheme Rules, protocols and available benefits.
  • Your authorisation has an expiry date – the healthcare service must commence within three months of authorisation
  • The availability of funds is considered at the time of enquiry - funds for the service authorised will not be 'booked' or guaranteed
  • In many cases, your healthcare provider or hospital assists you with the authorisation process, but you, the member, stay rsponsible for obtaining authorisation.
  • In case of emergencies, please call us for authorisation on the next working day.

We have a dedicated team to assist you with your authorisation and to answer all your questions. Call the authorisation team on 0860 222 633.

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