Understanding Hospital Authorisation: What You Need to Know

Hospitalisation can be a stressful experience but understanding how your medical scheme's authorisation process works can help ease the journey. The UKZN Medical Scheme offers a Hospital Benefit that covers a wide range of in-hospital expenses but to access this benefit fully, members need to follow the correct authorisation steps.

What Is Hospital Authorisation?

Hospital authorisation is the process of getting approval from the medical scheme before being admitted for a planned procedure or treatment. This ensures that your hospital stay is covered and that the scheme can manage costs effectively.

Why Is Authorisation Important?

Without authorisation, your hospital expenses may not be covered or may only be partially covered, leaving you with unexpected bills. Authorisation confirms that:

  • Your procedure is medically necessary.
  • The hospital is part of the Scheme's network.
  • The costs align with the Scheme's agreed rates.

When Should You Request Authorisation?

For planned hospital stays, you must contact the Scheme at least 48 hours before admission. This applies to:

  • Scheduled surgeries
  • Specialist treatments
  • Diagnostic procedures requiring hospitalisation

Using Network Hospitals

Hospital authorisation is your gateway to stress-free, covered care. Always plan ahead, use network hospitals, and contact the Scheme early to ensure your treatment is approved and your costs are covered.

For authorisation or queries, contact the UKZN Medical Scheme directly, Call: 0860 11 33 22 or Email: service@ukznms.co.za.

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