Issue link: https://www.hub.camaf.co.za/i/1512932
2024 NETWORK CHOICE 16 Pre-authorisation Which hospitals form part of the Network? The Netcare group of hospitals forms part of the network see www.camaf.co.za. For any procedure / surgery in hospital referral must come through your nominated network GP or specialist. Which services require pre-authorisation? 1. All non-emergency admissions to hospital - at least 24 hours before admission - emergency admissions should be authorised within 48 hours or on the first working day following the event, by calling 0860 100 544, emailing to preauth@camaf.co.za or online at www.camaf.co.za 2. Step-down facilities 3. Home nursing (post-hospitalisation) 4. Advanced radiology e.g., MRI, CT and PET scans 5. Endoscopies - in or out of hospital If I obtain authorisation, is this a guarantee of payment? In all cases where prior approval and authorisation by the Fund or by any service provider on its behalf ("Pre- authorisation") is required in respect of any benefit, even though such pre-authorisation may be given, the payment of any claim relating thereto will always be subject to: • sufficient benefits being available to the Member at the time of payment, • that the Member has made full disclosure of relevant information in his or her application for such pre- authorisation; and • further that his or her membership has not been terminated or suspended for any reason. What information is needed to obtain authorisation? • Hospitalisation, home nursing and step-down facilities - CAMAF requires the name of the hospital or institution and practice number if possible, the practice number of your nominated network GP, the name and type of doctor that is going to treat you or operate, and the ICD10 code for the condition resulting in your admission. • Advanced radiology - the practice name and practice number if possible, the code for the scan to be conducted and the ICD10 code for your condition. How can I obtain pre-authorisation? Pre-authorisation is obtained by contacting 0860 100 544, via CAMAF Mobile App or online www.camaf.co.za - from the Member's or the Provider's login on the website. What happens if I do not obtain pre- authorisation for a scheduled procedure / admission? Failure to pre-authorise may result in non-payment of your claims or a penalty being imposed (20% of the amount claimed up to a maximum of R2 500). What happens if my stay in hospital is longer than the original approved length of stay? Your doctor would need to motivate and request a longer stay in hospital, should it be medically necessary. The hospital would contact CAMAF in this regard. How is the medication, given to me on discharge from hospital to take home, paid? CAMAF allows for a 7 day supply of medication to be paid from your hospital benefit, thereafter you should obtain a prescription from your treating doctor, which would be dispensed and processed in the normal way. BACK TO CONTENTS PAGE