Q What is a designated service provider (DSP)?
A DSP is a healthcare provider or group of providers selected by the Scheme as the preferred provider or providers to provide to its members diagnosis, treatment and care in respect of one or more prescribed minimum benefit conditions. However, members may only access these services through a GP and with authorisation from Case Management. The DSP list is available on request from Case Management, Client Liaison or can be downloaded from the Platinum Health website at www.platinumhealth.co.za. 

Q What is an authorisation and when do I need it?
A It is the process of obtaining approval from the Scheme for specialist consultations, hospital admissions, managed-care programmes such as maternity and oncology and specialised radiology investigations e.g. MRI, CT and PET scans.

An authorisation number will be issued by Platinum Health Case Management within the rules and benefits according to the member’s option. Need assistance? Contact Case Management on 014 590 1700 or 080 000 6942

Q Do I need authorisation to consult a Paediatrician or Gynaecologist?
A Yes. PlatComprehensive and PlatCap members need to obtain authorisation from Case Managent. Paediatricians and Gynaecologists are specialists and therefore authorisation numbers are needed.
Need assistance? Contact Case Management on 014 590 1700 or 080 000 6942.

Oncology Programme
Is subject to scheme benefits per option. Members have to register through Case Management, as soon as a cancer diagnosis is made. Chemotherapy and radiotherapy are subject to clinical protocol approval and pre-authorisation by the Scheme.

Kidney Disease Programme
Should kidney failure occur, members have to register on the Kidney Disease Programme through Case Management. Renal dialysis and kidney transplant are subject to clinical protocol approval and pre-authorisation, per option, by the Scheme.

Oxygen Programme
This programme conveniently offers oxygen at home for patients, making life more comfortable and manageable.
Is subject to clinical protocol approval and pre-authorisation by the Scheme. Need assistance? Contact Platinum Health Case Management on 014 590 1700 or 080 000 6942

Specialist Referrals

Q What is a specialist?
A Medical specialists are doctors who have completed advanced education and clinical training in a specific area of medicine (their specialty area).

How does it work?

Important to note: PlatComprehensive/PlatCap members need to obtain authorisation from Case Managegment prior to consulting specialists. PlatFreedom members don’t need authorisation to visit specialists’, however members still need to obtain authorisation from Case Management for in-and-out of hospital procedures and medical admissions, specialised radiological investigations such as MRI, CT and PET scans and managed care programmes such as maternity, oncology, renal dialysis etc.

• Member has to visit a General Practitioner with a specific condition/problem.
• If necessary the GP will refer member to specialist for further treatment.
• GP will give member detailed clinical referral letter on specific condition.
• Referral letter to be send to Case Management by either patient or Platinum Health facility.
• Case Management will evaluate the request with assistance of Medical Advisor.
• If referral request is approved, appointment will be made with the relevant specialist by Case Management.
• Member will receive authorisation number via SMS, email, telephone or from Platinum Health facilities.
• Copy of referral letter, X-rays, blood results and all related documentation to be taken with to the specialist.
• Remember to give authorisation number to specialist to ensure payment of account.
• Authorisation number will be valid for only the date of consultation. If consultation date changes please inform Case Management to update on the system, to ensure correct payment.
• Follow-up visits are requested by the specialist. Before you can see the specialist again for a follow up visit, a feedback report from the specialist to PH Case Management is needed.
• The same authorisation process as first visit will apply.
• Emergency and after-hours specialist referrals can be arranged telephonically between GP and Case Management – Medical Advisor, however the documentation still needs to be send to Case Management afterwards.
• No authorisation – no payment of specialist account.
• Members who do not honour appointments, will be held liable for the cost of the appointment.
• Need assistance? Contact Case Management on 014 590 1700 or 080 000 6942

Maternity Programme

Maternity benefits are applicable per option.

How does it work?

• Member has to visit a General Practitioner to confirm pregnancy.
• If necessary the GP will refer member to Gynaecologist for further treatment.
• GP will give member detailed clinical referral letter.
• Referral letter to be send to Case Management by either patient or Platinum Health facility.
• Case Management will evaluate the request with assistance of Medical Advisor.
• If referral request is approved, appointment will be made with the relevant specialist by Case Management.
• PlatComprehensive/PlatCap members will receive authorisation number via SMS, email, telephone or from Platinum Health facility.
• Copy of referral letter, blood results and all related documentation to be taken with to the specialist.
• Remember to give authorisation number to specialist to ensure payment of account.
• Authorisation number will be valid for only the date of consultation. If consultation date changes please inform Case Management to update on the system, to ensure correct payment.
• Follow-up visits are requested by the specialist. Before you can see the specialist again for a follow up visit, a feedback report from the specialist to Case Management is needed.
• The same authorisation process as first visit will apply.
• Emergency and after-hours specialist referrals can be arranged telephonically between GP and Case Management – Medical Advisor, however the documentation still needs to be send to Case Management afterwards.
• No authorisation – no payment of specialist account.
• Members, who do not honour appointments, will be held liable for the cost of the appointment.
• Register on the Maternity Programme by completing and submitting the relevant documentation to Case Management via email, fax or at a Platinum Health facility.
• Before consulting with a specialist for follow-up visits, confirm how many visits and or ultra-sounds are allowed according to your Option.
• Ante-natal supplements are provided according to a member’s option benefits. If unsure, contact Case Management or Client Liaison.
• Member to book a bed at a hospital approved by the scheme.
• Platinum Health will fund a normal maternity bed as part of the delivery cost.
• After delivery, the principal member has to register the new-born baby within 30 days of birth.
• A hospital Confirmation/Notification document can temporarily be submitted together with the application, however, this document is only valid for 30 days. As soon as the new-born baby has been registered with the Department of Home
• Affairs, the member is responsible to submit a copy to the scheme within 30 days of birth.
• The new-born baby can be registered at the:
  – Employee Services Walk-in Centre at your workplace
  – Employee Benefits (EB) office at your workplace
  – Human Resources office at your workplace
  – Client Liaison office
• Platinum Health does not pay for ante-natal classes.
• The 6-weekly post-normal delivery or post C-section may not be claimed separately by the specialist as it is included in the delivery fee.
• Need assistance? Contact Case Management on 014 590 1700 or 080 000 6942 or Client Liaison