Member has to visit GP with a specific condition or problem. The General Practitioner will refer member to a specialist.

The GP issues a request for referral and gives it to the member. PlatComprehensive/Platcap members should use this request to obtain authorisation for the visit from Case Management.

The referral request from the GP should contain the following detail:

• The patient’ name, date of birth, medical scheme number, contact details
• The specialist’s details and practice number
• A detailed clinical referral letter (as well as whether or not the visit is related to an MVA or an IOD.
• The referring GP’s details and practice number

Tel: 014 590 1700 or 080 000 6942 OR
Fax: 086 247 9497 or 086 233 2406 OR
Platinum Health facilities OR
Email: plathealth@platinumhealth.co.za (specialist authorisation)

Authorisation will be valid for only the date of treatment.

• Case Management evaluates the request with the assistance of the Medical Advisor.
• PlatComprehensive/Platcap member receives an authorisation number via SMS, email, and telephone or from Platinum Health facility.
• Copy of referral letter, X-rays, blood results and all related documentation to be taken with to the specialist.
• member to give authorisation number to specialist.

• Case Management evaluates the referring request with the assistance of the Medical Advisor and reject referral.
• If PlatComprehensive/PlatCap members’ authorisation is rejected, the member will receive notification via SMS, email, telephone or from Platinum Health facility; stating the reason why authorisation request was declined.
• PlatComprehensive/PlatCap members can contact Case Management and Platinum Health facilities at their sites with regards to follow-up queries.

Specialists will be required to write a feedback report to the referring GP to ensure that he/she has clarity on the condition/treatment of his/her patients.

The letter requesting the follow-up visit should contain the following details:

• The reason for the follow-up visit or frequency of visits, with a full clinical report on diagnosis and treatment, required from treating specialist.
• The patient’ name, date of birth, medical scheme number, contact details

A copy of the required documentation should be submitted to Case Management for approval prior to the follow-up visit.

Case Management will capture the motivation/diagnosis and issue a follow-up authorisation number to the patient. This number is valid for only the date of treatment.

• Follow-up visits to specialists after hospitalisation/surgery have to be authorised by Case Management.
• On discharge, the specialist will inform the member when follow-up visits are required.
• This is usually two or six weeks after discharge.
• Contact Case Management with this information for approval and an authorisation number

Tel: 014 590 1700 or 080 000 6942 OR
Platinum Health facilities OR
Email: plathealth@platinumhealth.co.za
(specialist authorisation)

• Case Management evaluates the request with the assistance of the Medical Advisor.
• Member receives an authorisation number via SMS, email, and telephone or from Platinum Health facility.
• Copy of referral letter, X-rays, blood results and all related documentation to be taken with to the specialist.
• Member to give authorisation number to specialist.

• Case Management evaluates the referring request with the assistance of the Medical Advisor and reject referral.
• If a member’s authorisation is rejected, the member will receive notification via SMS, email, telephone or from Platinum Health facility; stating the reason why authorisation request was declined.
• Member can contact Case Management and Platinum Health facilities at their sites with regards to follow-up queries.