You need to obtain pre-authorisation from Momentum Medical Scheme for:
- Hospitalisation
- Day hospital admissions
- Specialised procedures/treatment
- MRI, CT, Magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans (you have to be referred by a specialist)
- All other Major Medical Benefits.
You need to obtain a separate pre-authorisation from Momentum Medical Scheme for any in-hospital physiotherapy and occupational therapy even if part of a hospital admission. All other auxillary benefits are limited to Prescribed Minimum Benefits at State Facilities.
We provide pre-authorisation once benefits have been verified and Scheme Rules and protocols have been applied. If the hospital or doctor obtains the authorisation on your behalf, it is important for you to check if you will need to pay any co-payments/shortfalls as a result of not using a Designated Service Provider/Preferred Provider, or as a result of any benefit limits and applicable co-payments.
How to obtain pre-authorisation
- Pre-authorisation for hospital admissions, specialised procedures/treatment and specialised scans can be obtained by logging in to the Momentum App
- You can also obtain pre-authorisation for the above as well as any other Major Medical Benefits by contacting our member call centre:
- WhatsApp us on +27860117859;
- Go to momentummedicalscheme.co.za and click on the help button to use the web chat facility;
- Email us at [email protected] or
- Call us on 0860 11 78 59.
- Remember to make a note of the authorisation number
- Give the authorisation number to your provider(s)
When you contact us, make sure you have the following information available:
- Your membership number
- The name and details of the patient
- The reason for hospital/day hospital admission, procedure/treatment or specialised scan
- The procedure code (CPT), diagnosis code (ICD-10) and tariff code (these details must be obtained from your treating doctor)
- The date of admission
- The contact details and practice number of the referring GP where applicable
- The contact details and practice number of the specialist
- The name and practice number of the hospital, day hospital or radiologist.
Frequently asked questions
Can an authorisation number be issued on the day of admission?
- Authorisation must be obtained at least 48 hours before admission, unless it is an emergency admission.
What happens if it is an emergency situation?
- You, a family member or friend must contact us within 72 hours of admission.
What if I do not get authorisation in time?
- There will be a co-payment of 30% that will apply to all claims relating to the event. Momentum Medical Scheme will be responsible for 70% of the negotiated tariff, provided authorisation would have been granted according to the Rules of the Scheme.
What if the length of stay needs to be extended beyond the authorised period?
- The hospital needs to contact us to update the length of stay.
How does authorisation work for childbirth?
- Contact us within 30 days of your due date to ask for authorisation for your confinement. If your admission date changes, you have 48 hours from the date of admission to notify us.