Pre-authorisation at Profmed medical aid scheme serves to:
- alert the medical aid scheme to upcoming costly expenses
- allow the medical aid scheme to apply managed care interventions and protocols
- limit the risk to membership by ensuring only clinically necessary and cost-effective treatment is funded
- inform members of the limit in respect of the procedure or treatment for which they are requesting authorisation; and
- give members the opportunity to query their benefits in respect of the procedure or treatment being authorised.