KeyHealth Authorisation Contact Details

KeyHealth runs authorisations on a different number from its general client service line, and the two differ by a single digit. Getting that one digit wrong is the most common reason a pre-authorisation call goes to the wrong queue.

Official provider route

Hospital pre-authorisation: 0860 671 060, [email protected]
Dental pre-authorisation, handled by DENIS: 0860 104 926, [email protected]
Oncology management programme: 0860 671 060, [email protected]
Disease Risk Management Programme: 0860 671 060, [email protected]
Chronic medication registration, for use by providers: 0800 132 345
Client Service Centre for everything else: 0860 671 050, [email protected], WhatsApp 060 976 8319

Note the pair carefully. Authorisations and the clinical programmes run on 0860 671 060, while membership, claims queries and general service run on 0860 671 050. Sixty against fifty is the only difference. The Client Service Centre is open Monday to Friday from 07:30 to 18:00, excluding public holidays.

Product or service support

Not every authorisation is handled by KeyHealth itself, and that catches people out. Dental pre-authorisation goes to DENIS, a separate administrator with its own number and mailbox. Optical management is handled by IsoLeso on 011 340 9200. Disease management runs through LifeSense on 0860 50 60 80. Sending a dental authorisation request to the hospital pre-authorisation address will not get it done.

An emergency is different again and should not go to an authorisation line at all. The scheme publishes Netcare 911 on 082 911 as its crisis line and ambulance number. Call that first and sort the authorisation out afterwards, because nobody should be negotiating a reference number while somebody needs an ambulance.

Eligibility, account or policy requirements

For a planned admission, authorisation is obtained before you go in, not on the day you arrive and not afterwards. Have the membership number, the treating provider and hospital practice numbers, the date of admission, and the diagnosis and procedure codes ready before you call. Your doctor rooms will have the codes, and a call without them usually ends in a second call.

For an emergency admission the rule is different: the admission is reported to the scheme as soon as possible afterwards rather than in advance, and the scheme rules set the deadline for that, so check your rules or ask on the authorisation number. A late report is a common cause of a rejected account. Note also that Prescribed Minimum Benefit conditions must be covered by any scheme, though usually only if you use a designated service provider, so ask whether the hospital you are being sent to is one before you agree.

Escalation route

If you need to deal with the scheme in person, it runs walk-in offices from Monday to Friday between 07:30 and 15:30, excluding public holidays. Those close two and a half hours earlier than the call centre. Only one of them publishes a telephone number.

Centurion: PPS Centurion Square, corner Gordon Hood and Heuwel Roads
Gqeberha: 170 Cape Road, Mill Park, 041 373 0020
Cape Town: 28A Wale Street, no office telephone number published
Polokwane: 41 Hans van Rensburg Street, no office telephone number published
Durban: 236 on Ninth Avenue, Windermere Centre, no office telephone number published
Postal address: KeyHealth Medical Scheme, PO Box 14145, Lyttelton 0140

If an authorisation or a claim is refused and you cannot resolve it on the numbers above, use the scheme complaints process first so that there is an internal record and a reference. Beyond the scheme, medical schemes in South Africa are regulated by the Council for Medical Schemes, which handles member complaints once the scheme has had its opportunity to answer. Suspected fraud has its own route, on 087 023 0161 or [email protected], and that line is for reporting fraud rather than for disputing your own claim.

Sources

KeyHealth contact details and walk-in offices: keyhealthmedical.co.za/contact-us
KeyHealth Medical Scheme: keyhealthmedical.co.za