Pre-Authorisation Information

Pre-authorisation at Profmed medical aid scheme serves to:

• alert the medical aid scheme to upcoming costly expenses;
• allow the medical aid scheme to apply managed care interventions and protocols;
• limit the risk to the membership by ensuring only clinically necessary and cost-effective treatment is funded;
• inform members of the limits in respect of the procedure or treatment for which they are requesting authorisation; and
• give members the opportunity to query their benefits in respect of the procedure or treatment being authorised.

Authorisation does not guarantee payment. Funding of treatment or investigations that are pre-authorised is always subject to the funds available per the option the member has chosen and the protocols of the Scheme. Doctors' and specialists' fees are not included in the authorisation. Where pre-authorisation is required, the number to call is 0860 776 363. From within the SADC Region call
+27 12 679 4145.