Admission into a private hospital is not by choice. A medical doctor has to admit a patient and the medical aid has to approve payment before the hospital will allow you admission. These days you will have to wait for an available bed at times in the hospital of your choice as the demand on private health facilities in South Africa continue to grow. Before you show up at a hospital, it is important that you understand how the hospital admission procedure works or you may be refused admission or even held liable for the hospital bills.
Getting Admitted Into Hospital
Firstly, private hospitals in South Africa require that you have some means to pay for hospital care. This is either through an active medical aid plan or cash upfront to pay for your bills. A hospital cash back plan will not do as this is a type of insurance policy that pays you for each day that you are in hospital. Even though a hospital cash back plan can pay quite a substantial amount, private hospitals do not recognise these types of insurance policies as a guarantee of payment for the medical care that you will require while in hospital.
You have to have a legitimate reason for being hospitalised. Contrary to what many people think, you cannot just opt to be in hospital to take a break from work for a few days or collect a payout on your hospital cash back plan. Your medical aid in particular requires a legitimate reason for hospitalisation as motivate by a medical doctor who is treating you. These days you cannot try to get into hospital just to undergo tests and have your medical aid hospital plan pay for it when it could have been done on an outpatient basis.
Authorisation Number
Your doctor or you will have to phone the medical aid and request an authorisation number for hospitalisation. This authorisation number is a means of confirming that your medical aid is aware that you will be hospitalised and will therefore pay for the subsequent bills. Most private hospitals require that you have an authorisation number or they will refuse you admission. If it is an emergency and you cannot speak for yourself then the hospital will contact your medical aid and complete the relevant hospitalisation procedures. Otherwise the onus is on you as the medical aid member to get the authorisation number and provide it to the private hospital at the time of admission.
The authorisation number is also used by all the doctors and service providers who treat you in hospital as a means of getting reimbursed for their services. In the case of pregnancy, it is important to get an authorisation number many months before you are due to deliver your baby. In this way your medical aid is aware of the pregnancy and upcoming delivery and it will speed up the admission process once you go in labour. It is important to do this early as you could go into preterm labour and have to go to hospital as early as the 7th or 8th month of pregnancy. Without an authorisation number, you can be dragged down with admission procedures at a time when you need immediate medical care.
Duration of Hospital Stay
You cannot stay in hospital indefinitely once you medical aid has approved hospitalisation and provided an authorisation number. Medical aids restrict the number of days you can remain in hospital based on their assessment of what is a reasonable duration for a hospital stay given your medical condition. At the time of submitting the authorisation number, the medical aid has already predetermined the approximate amount of time for which you should be in hospital. The authorisation number is therefore only valid for this duration of the hospital stay, after which you will have to be discharged or held liable for the medical bills.
If you need to stay in hospital for a longer period, your doctor can motivate to your medical aid as to why a longer duration is necessary. It is not always clear as to how long you can stay in hospital because medical aids are aware that in some situations it is difficult to accurately determine the duration of the hospital stay. Whatever the case, you as the patient and medical aid member need to be clearly aware of the duration of your hospital stay as approved by your medical aid to prevent any unforeseen expenses. Trying to force your doctor or the hospital to keep you longer is pointless as it is the decision of your medical aid as to how long you can stay in hospital.