Medical Case Management
Benefits offered by Medical Case Management
A group of highly trained professionals who can assist you with the following:
· Personalised case management of all hospital event.
· Your treatment and level of care is monitored continuously.
· This includes continuous liaison with your doctor, the hospital and your family.
· Emotional support and counselling of you and your family if they are hospitalised.
· Planned treatment is independently assessed and discussed with your doctors to ensure that it is medically correct for the patient's condition, age profile and medical history.
· Pre-authorisation to approve procedures that fall under the Private Hospital Benefit.
· Advice on medical conditions.
Obtaining pre-authorisation
Call our dedicated pre-authorisation line at 0860 100 512.
Please supply the following information:
· Principal member's name.
· Patient's name and date of birth.
· Date of treatment.
· Treating doctor.
· The name of the hospital/facility.
· Type of procedure/treatment being done.
Benefits of the pre-quote system and pre-authorisation
· You have peace of mind that your in-hospital claims will be covered by Cape Medical Plan.
· Service providers are assured of payment.
· Personalised support from a case manager who will be on hand to assist you and answer all your questions.
Pre-authorisation requirements
Unless in the case of an emergency, all pre-authorisations are suject to a pre-quote. Our case managers will help in assisting you to obtain the quotation needed.
You will need pre-authorisation for the following:
· All hospital admissions.
· MRI and CT scans.
· Radio Isotope scans.
· Renal Dialysis.
· Nursing/Step Down facilities.
· Hospice.
· All Oncology treatment.
· Any procedures, which would ordinarily require hospitalisation, eg. Gastrocopy, Colonoscopy.
· Any additional treatment to be received that was not originally pre-authorised.