Hospital care and procedures

Hospital building vs being in hospital

We pay for treatment and care you receive while admitted to hospital from the Hospital Benefit. We do not pay for all healthcare you receive in a hospital building from the Hospital Benefit. There is a difference between being hospitalised and visiting a Healthcare Professional who has an office inside the hospital building.

When we say you are in hospital, admitted to hospital, or hospitalised, we mean that you had to sign in to hospital at reception and that you have a hospital bed. We pay for procedures, and your hospital stay in this case from the Hospital Benefit without using your day-to-day benefits.

We pay for healthcare you receive in the hospital building (like visits to the casualty unit, visits to specialists, scans and blood tests) from your day-to-day benefits if you do not have a hospital bed.

Hospital pre-authorisation

If you are admitted to hospital in an emergency, please contact us for authorisation within 48 hours. You must get authorisation before you are admitted to hospital for a planned procedure. Contact us for pre-authorisation as soon as you and your Healthcare Professional have agreed on a date for admission by:

If your Healthcare Professional contacts us and gets authorisation on your behalf, you have to make sure you receive all the information about the authorisation from the Healthcare Professional. You cannot hold Bankmed responsible if your Healthcare Professional does not share this information with you. This includes information about:

  • What we cover and what we do not cover
  • Upfront payments (deductibles) to the hospital before you receive treatment
  • How much you have to pay yourself (co-payments and shortfalls)

Ask your treating Healthcare Professional for the following information and give it to us when you contact us for pre-authorisation:

  • Your treating Healthcare Professional’s practice number
  • Name of the hospital to which you or your dependant will be admitted
  • The date of admission
  • The diagnosis code (ICD 10 code)
  • Any tariff and procedure codes

We send you and the hospital an authorisation letter as soon as the admission is approved. If we have your cellphone number, we also send you an SMS with pre-authorisation details.

Pre-authorisation does not mean we pay all the costs for your hospital stay

When we give you pre-authorisation, we confirm that your hospital admission meets our clinical guidelines for funding. It does not guarantee we will cover all the costs related to the hospitalisation as this depends on your Plan’s limits. Always check your Plan limits if you are unsure: