Ask about the actual appointment
Give the scheme the provider details and the planned service. Ask whether the referral, procedure codes or clinical motivation need to be supplied by your treating practitioner. Keep the reference number and written response.
Authorisation and payment are different questions
Ask what has been authorised, which benefit applies, what limits remain and whether the provider charges more than the amount payable. An authorisation number should not be treated as an unconditional promise that every charge will be paid.
If an authorisation is declined
Ask for the reason in writing and what information or review process is available. Your treating practitioner may need to clarify the clinical information. Medical Aid Hub can help follow up the administrative query and organise the response.
For emergencies, seek urgent medical care rather than waiting for routine authorisation. Ask the scheme about notification requirements as soon as reasonably possible.
Sources and further reading
General information. Your scheme rules and individual circumstances matter. Contact your scheme or an appropriately qualified adviser for a decision about your situation.