How to Get Hospital Authorisation from Medical Aid

Direct answer and safest next step

First step

To get hospital authorisation (also known as pre-authorisation) from your medical aid, you must contact your medical scheme directly through its official portal, mobile app, or dedicated pre-authorisation telephone line or email address before you are admitted for planned treatment. In the case of an emergency admission, hospital authorisation must typically be obtained within 24 to 48 hours following admission, either by yourself, a family member, or the hospital admissions desk.

The safest first step is to check the back of your official medical aid membership card or log in to your scheme’s secure member portal or official mobile app to locate the verified pre-authorisation department details. Do not rely on unverified phone numbers, third-party internet directories, or social media posts to submit sensitive personal or medical information. Always verify exact contact details on the official provider website before submitting documents or making enquiries.

Which official source to check

Official source check

When seeking hospital pre-authorisation in South Africa, always consult the official website, member portal, or customer self-service app of your specific medical scheme (such as Discovery Health, Bonitas, Momentum, Bestmed, Medihelp, or Sasolmed).

Different medical schemes have distinct clinical management departments, network hospital requirements, and pre-authorisation channels. Furthermore, if you are seeking information regarding mandatory treatment rights, emergency admissions, or Prescribed Minimum Benefits (PMBs), the official regulator is the Council for Medical Schemes (CMS).

Key points to verify on official channels:

• Approved Hospital Networks: Ensure the hospital or day clinic is part of your specific plan’s designated service provider (DSP) network to avoid unexpected co-payments.
• Authorisation Protocols: Check whether your scheme requires pre-authorisation online, via email, or over the phone.
• Clinical Requirements: Confirm if specific procedures require clinical motivation letters from your specialist prior to approval.

Note: ContactDetails.co.za is an independent information directory and guide. It is not a medical scheme, clinical administrator, or regulatory body, and cannot grant hospital authorisations or process medical claims.

Information or documents to have ready

Evidence/documents

To ensure your pre-authorisation application is processed smoothly without delay, gather all clinical and personal details provided by your treating healthcare practitioner before contacting your medical scheme.

Have the following safe details ready:

• Membership Information: Your medical scheme name, main member number, and the dependant code for the patient being admitted.
• Healthcare Provider Details: Name and practice number of the admitting doctor or specialist, as well as the practice number of the hospital or day clinic.
• Clinical & Procedure Codes: Diagnostic ICD-10 codes and procedure/tariff (CPT) codes, which must be provided by your doctor’s receptionist or specialist.
• Admission Details: Proposed date of admission, date of surgery (if applicable), and estimated duration of hospital stay.

Safety Warning: Never share account passwords, online portal login credentials, PINs, bank account passwords, or One-Time Passwords (OTPs) with anyone during the authorisation process. Official medical scheme agents will only request clinical, medical, and personal identification details relevant to your scheme policy.

Always make a written note of the date, time, customer agent name, reference number, and official authorisation number given once approved, as the hospital admissions desk will require this code upon arrival.

When to complain or escalate

Escalation trigger

If your pre-authorisation request is delayed, partially approved, or declined, you should follow a direct, step-by-step resolution process:

1. Request Written Reasons: Contact your scheme’s clinical management team directly to obtain a formal written reason for denial or partial coverage (e.g., missing clinical codes, non-covered benefits, or exclusion periods).
2. Submit Doctor’s Motivation: Ask your attending specialist to submit a detailed clinical motivation letter or additional medical diagnostics to the scheme’s medical review panel or dispute committee.
3. Internal Scheme Dispute: Submit a formal complaint or appeal to the medical scheme’s internal disputes committee following their official escalation route.
4. Escalate to the Ombud/Regulator: If the internal dispute process fails and you believe your benefit rights or PMB entitlements have been infringed, submit a formal dispute to the Council for Medical Schemes (CMS) via their official regulatory complaints channels.

Scam and safety checks

When searching online for medical aid contact channels or hospital pre-authorisation desks, protect yourself against online fraud, identity theft, and financial scams:

• Fake Phone Numbers & Phishing: Cybercriminals often post fake support numbers on internet search results, forums, or third-party directories to intercept personal details. Always confirm numbers against your medical scheme membership card or official website domain.
• Payment & Refund Scams: Pre-authorisation processes do not require upfront payments to third-party agents over the phone. Be wary of callers claiming you owe an immediate “authorisation fee” via payment links, e-wallets, or bank transfers.
• OTP & Credential Theft: No legitimate medical scheme or hospital representative will ever ask for an OTP sent to your phone or your internet banking credentials to issue an authorisation code.
• Vishing and Smishing: If you receive an SMS or voice call requesting personal details regarding a hospital stay, do not click embedded links or disclose information until you have independently called the official customer care number found on your scheme card.

Related ContactDetails.co.za pages

Related support route

To help you find verified official routes for medical schemes and related support services, refer to our planned guide pages:

• Search for verified official support channels across schemes on our Medical Aid Contact Details South Africapage.
• Review general guidance on pre-approval procedures at Hospital Authorisation Contact Details.
• Access full customer care routing indices via our Guides Contact Pages section.

Frequently Asked Questions

What is the best way to use the How to Get Hospital Authorisation from Medical Aid page?

Use this guide to identify the exact documents and diagnostic codes needed from your doctor before navigating to your official medical scheme’s portal or contact channel. Follow the recommended safety checks to avoid fake numbers or phishing scams.

Where should users verify how to get hospital authorisation from medical aid?

Users should verify contact numbers, email addresses, and member portal URLs directly on their official medical scheme’s website, mobile app, or on the back of their physical medical aid card.

What details should users prepare before contacting support?

You should prepare your membership number, dependant code, admitting doctor’s practice number, hospital practice number, admission date, and the specific ICD-10 and procedure/tariff codes supplied by your doctor.

What should users do if they cannot get help?

If you face delays or an unfair denial, request a formal clinical motivation from your treating specialist for resubmission. If unresolved internally by your scheme, you may escalate the issue through the formal complaint process provided by the Council for Medical Schemes (CMS).