Overview
As a member of Bonitas Medical Fund, it’s essential to familiarize yourself with the pre-authorisation process to ensure your medical treatments are covered and to avoid unnecessary out-of-pocket expenses. Pre-authorisation is a crucial step where Bonitas verifies that a medical procedure or treatment is covered under your specific plan and is medically necessary.
This guide will walk you through the pre-authorisation process at Bonitas. Whether you’re preparing for a major surgery, a complex diagnostic test, or an expensive treatment, understanding this process will help you maximize your benefits and avoid any financial surprises.
When is Pre-authorisation required by Bonitas?
Pre-authorisation is a critical step required by Bonitas Medical Fund for all hospital admissions and certain procedures, both in emergency and non-emergency situations.
Members must submit pre-authorisation requests with comprehensive details, including procedure codes and healthcare provider information. Failure to include all required details can lead to denial of the pre-authorisation.
Even with pre-authorisation, members might face co-payments if healthcare providers charge above the Bonitas Rate. To minimize out-of-pocket expenses, it’s advisable to use designated service providers and obtain gap cover insurance for additional protection.
What information to provide when requesting pre-authorisation
When applying for pre-authorisation from Bonitas, you need to provide the following information:
- ✅ Membership number
- ✅ Details of the member for whom the request is made
- ✅ Dates of hospital admission and treatment or procedure
- ✅ Name of the treating doctor, their telephone number, and practice number
- ✅ Name of the hospital, their telephone number, and practice number
- ✅ Relevant procedure and diagnosis codes (ICD-10 codes) for the treatment
This detailed information helps ensure that the pre-authorisation process is smooth and that potential coverage is appropriately assessed.
How to get Bonitas Medical Fund Authorisation
To apply for pre-authorisation from Bonitas, follow these steps:
- ✅ Collect all required information such as your membership number, details about the hospital admission, and your healthcare provider’s details.
- ✅ Call the Bonitas pre-authorisation number or log in to your member profile online to submit your pre-authorisation request.
- ✅ Provide your membership details, dates of the procedure, doctor’s and hospital’s names and contact details, and the relevant medical codes (ICD-10 and procedure codes).
- ✅ Complete and submit your pre-authorisation form with all the required details.
- ✅ Wait for Bonitas to review and approve your request. You will receive a pre-authorisation number and details about the coverage.
Conclusion
By following the steps outlined in this comprehensive guide, the pre-authorisation process at Bonitas Medical Fund should be clear and manageable.
With this information, you can confidently approach the pre-authorisation process, ensuring that you fully utilize the benefits of your Bonitas health plan while avoiding potential complications during your healthcare journey. Remember, Bonitas is committed to supporting you through each step, ensuring that you receive the necessary care without undue stress or confusion.
