Having a medical procedure?

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Remember these important things you should ask your doctor

Asking your doctor about your procedure and the paperwork may seem furthest from your mind when you consider a medical procedure. However, having these all important ducks in a row will go a long way to ensure you don’t have to worry about your claims later on.

Can the procedure be done in the doctor’s rooms?

Nowadays, many basic medical procedures can be done in a doctor’s rooms so be sure to ask if this will be possible to save on in-hospital expenses and help your benefits last longer.


Who will be getting pre-authorisation for the procedure?

Ask your doctor if his rooms will be calling us to pre-authorise the procedure or if you need to.  Remember, if it’s a non-emergency procedure that you are going to have over the next few weeks,, you need to ideally call us 14 days beforehand.  If it’s an emergency, you need to get in touch with us within 48 hours of the procedure.  Remember, if your procedure wasn’t pre-authorised, you won’t be covered.  We’ve included a super handy pre-authorisation checklist at the end of this article to make this process as simple and easy as possible.


Could added care be necessary?

It’s important to understand whether there may be additional procedures or care that could crop up after the initial procedure.  Ask your doctor to make sure he keeps us up to date with any extra items that need to be added to your pre-authorisation.  Once again, this needs to be done within 48 hours of treatment to make sure you’re covered.


How much will it cost?

You’re entitled to get a written quote from your doctor to make sure you have the benefits available for the procedure.  Discuss this cost with them as well as any added extras that may crop up.


Who will be submitting the claim?

It’s important to agree with your doctor as to who will be submitting the claim to the Scheme.  This will ensure that duplicate claims are avoided, or worse, the claim is not submitted at all and subsequently becomes stale.  Remember, all claims must be submitted within 4 months of the service date.

Your pre-authorisation checklist

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