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Profmed Medical Aid Authorisations Contact Details
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Pre-authorisation is based on clinical criteria, not on the availability of benefits and is not a guarantee of payment. Benefits are funded subject to the benefit limits and availability of funds at the time the claim is received by the Scheme for processing, and in accordance with the relevant protocols and Scheme rules. Authorised services or treatment must commence within three months of authorisation.
Authorisation does not include the fees charged by the attending medical practitioners. It is the member’s responsibility to obtain pre-authorisation, which should be obtained at least seven days prior to the commencement of treatment or services. In cases of after-hours emergencies, authorisation must be obtained the next working day. Reimbursement of services that were authorised is dependent on the availability of funds at the time the Scheme receives the claim. Funds are not reserved when authorisation is granted.