What is pre-authorization?
This is the process whereby you notify the scheme that you are about to be hospitalized or that you want to access benefits for which pre-authorization is required. Services and treatments that require a pre-authorization is indicated on the benefit options. The scheme will confirm what benefits and amount of benefit that is available.
For what do I need pre-authorization?
• Any hospital admission (including Psychiatric hospitalization)
• Procedures in doctor’s rooms
• Maternity benefits
• MRI/CT Scans and radio isotope studies, interventional radiology and specialized radiology
• Access to Chronic and HIV/AIDS Medicine Benefit
• Dental surgery and specialized dentistry
• Refractive Surgery
• Basic dentistry in hospital for children under the age of seven
• Services and treatment as indicated on benefit options
How is pre-authorization obtained?
Pre-authorization is obtained by contacting the Scheme on 362 4700. Please have your membership number at hand.
Your service provider may also request pre-authorization on your behalf.
The service provider needs to provide the diagnosis; the intended treatment and estimated cost in writing as verbal pre-authorization will not be permitted. This is subject to assessment.
A pre-authorization number will be issued for the specific event as listed above or indicated in the benefit structure upon approval.
Failure to acquire pre-authorization?
If a member needs emergency treatment outside of working hours or on the weekend then pre-authorization can be requested on the next working day.
Claims submitted without pre-authorization will be rejected whether the claim is payable to the member or the service provider.
19 August ,2015
We have now moved to the CBD at Zambezi towers. We are next to the
19 August ,2015
We are now part of Metropolitan Botswana bridging the gap between Life and health insurance.