Healthcare / Medical Schemes

Pre-authorisation and payment: Do you know the difference?

Medical aid members know that pre-authorisation ahead of a medical procedure is always required but does pre-authorisation mean it’s an agreement to pay in full? No, not necessarily. This is the cause of a great deal of confusion and unhappiness from medical aid members as well as doctors and hospitals. Gerhard Van Emmenis, Principal Officer of Bonitas Medical Funds says, ‘Pre-authorisation is required for all hospital admissions, including emergencies. However, it is not an agreement to pay all the costs and expenses in full.’ Why not? Let’s take you through the Ts and Cs.

The shock, devastation and wrath of non-disclosure – who is to blame and who suffers?

Join a medical scheme while you’re still young: your future self will thank you

Joining a medical scheme when you’re young is probably the last thing on your to-do list. You’re young and healthy, so why do you need medical cover, right? Well, the answer is simple. Your future self will thank you in the years to come.

Fraud, waste and abuse

According to the Association of Certified Fraud Examiners (ACFE) SA, healthcare fraud, waste and abuse syphon huge amounts of money from the South African economy each year. One expert puts the figure at R930 million per annum.