Pre – Authorisation process

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Pre-Authorisation

What is Pre-Authorisation?

Pre-authorisation is the process whereby you notify the scheme that you are about to be hospitalized or that you want to access benefits for which pre-authorisation is required. Services and treatments requiring pre-authorisation are indicated on the benefit options. The scheme will confirm which benefits and the amount of benefit that is available.

For What Do I Need Pre-Authorisation?

Any hospital admission (including psychiatric hospitalization).
Procedures in doctors’ rooms.
Rehabilitation.
Maternity benefits.
MRI/CT scans, radioisotope studies, interventional radiology, and specialized radiology.
Access to Chronic and HIV/AIDS Medicine Benefit.
Dental surgery and specialized dentistry.
Refractive surgery.
Basic dentistry in hospital for children under the age of seven.
Services and treatments as indicated on each benefit option.

How Is Pre-Authorisation Obtained?

Pre-authorisation is obtained by contacting the scheme on 3624700 or by sending an email to botsogopre-authorisation@metropolitan.co.bw . Please have your membership number available when making the request. Your service provider may also request pre-authorisation on your behalf. The service provider must provide the diagnosis, intended treatment, and estimated cost in writing. Verbal pre-authorisation requests will not be permitted and are subject to assessment. Upon approval, a pre-authorisation number will be issued for the specific event listed above or as indicated in the applicable benefit structure.

Failure to Acquire Pre-Authorisation

If a member requires emergency treatment outside normal working hours or during the weekend, pre-authorisation may be requested on the next working day. Claims submitted without the required pre-authorisation will be rejected, whether the claim is payable to the member or the service provider.

Emergency Situations

What Constitutes an Emergency?

An emergency is the onset of a sudden and unexpected health condition that requires immediate medical or surgical treatment. Without prompt treatment, it may result in serious impairment of bodily functions, serious dysfunction of a bodily organ or part, place the person’s life in serious jeopardy, or even result in death.

Procedure to Be Followed

Call the Emergency Service Providers directly or contact Botsogo Health Plan on +267 73014111 for immediate paramedic assistance. Depending on the situation, proceed to your nearest emergency medical facility or hospital.

Tel : 3624700

Pre – Authorisation process