Letters
Hospital pre-authorisation request letter template
By Naledi Mokoena · 5 min read · Updated 24 June 2026
To get a planned hospital procedure approved, request pre-authorisation from your scheme before admission, giving the procedure, the ICD-10 and tariff codes, the hospital and the admission date. Skipping pre-authorisation usually means a penalty, even when the procedure is fully covered.
Use the template below for planned admissions. For emergencies, the scheme allows you to authorise shortly after, usually within 48 hours.
Always get an authorisation number before you are admitted, and take it with you to the hospital.
When you need pre-authorisation
Schemes require pre-authorisation for planned hospital admissions, scopes, scans (MRI and CT), and many procedures. Get it before the date. For a genuine emergency, you or the hospital must notify the scheme shortly after admission, usually within 48 hours, so the scheme can authorise it retrospectively.
Pre-authorisation request template
[Your full name]
[Membership number]
[Email] | [Cellphone]
[Date]
The Pre-authorisation Department
[Scheme name]
RE: Pre-authorisation request - member [MEMBERSHIP NUMBER]
Dear Sir or Madam,
Please authorise the following planned admission.
Patient: [PATIENT NAME AND DEPENDANT CODE]
Procedure: [DESCRIPTION]
ICD-10 code: [ICD-10 CODE]
Tariff / procedure code: [CODE]
Treating doctor: [NAME AND PRACTICE NUMBER]
Hospital: [HOSPITAL NAME]
Planned admission date: [DATE]
Please confirm the authorisation number, any co-payment, and whether the hospital and doctor are in network.
Yours faithfully,
[Your full name]
[ID number]
Check the co-payment before you go in
When the scheme gives the authorisation, ask what co-payment applies. Many plans have fixed co-payments on scopes, scans and certain procedures, and a penalty if the hospital is out of network. Knowing the amount upfront lets you budget, switch to a network hospital, or claim it from gap cover.
Keep the authorisation number
The authorisation number is your proof the procedure was approved. Give it to the hospital admissions desk and keep your own copy. If a claim is later queried, the authorisation number is the fastest way to resolve it. No number, and the scheme may apply a penalty even on covered care.
Frequently asked questions
Do I need pre-authorisation for hospital?
Yes, for planned admissions and many procedures, scopes and scans. Request it before the date with the procedure and codes. For a real emergency, notify the scheme shortly after admission, usually within 48 hours, to authorise it retrospectively.
What happens if I do not get pre-authorisation?
Schemes usually apply a penalty, often a percentage of the claim, even when the procedure is otherwise covered. Always get an authorisation number before a planned admission and give it to the hospital at admission.
How do I authorise an emergency admission?
You or the hospital must notify the scheme as soon as reasonably possible, commonly within 48 hours of admission. The scheme then authorises it retrospectively. For a genuine emergency you should not be penalised for not pre-authorising.
Will there be a co-payment even if it is authorised?
Possibly. Authorisation confirms cover, but a fixed co-payment can still apply to scopes, scans and certain procedures, plus a penalty for an out-of-network hospital. Ask for the co-payment amount when you get the authorisation number.
Who applies for pre-authorisation, me or the hospital?
Either can, but the responsibility is yours. The hospital or specialist often does it, but confirm the authorisation number yourself before admission rather than assuming it was done.
Can I claim an authorised co-payment back?
Often from gap cover, which is designed to refund hospital co-payments and shortfalls. The scheme itself will not refund a standard co-payment, but a gap policy may. Check your gap cover sub-limits.
