Considered,
not complicated.

Before you call or email:

To successfully log a pre-authorisation, you or your treating doctor must have the following details on hand:

• Patient's name, date of birth, and identity (ID) number
• Lion Health membership number
• Name, contact number, and practice number of your admitting doctor or specialist
• Name, telephone number, and practice number of the hospital or day clinic
• Exact date of the procedure or hospital admission
• Diagnosis code (ICD-10) and procedure codes (CPT/tariff codes), which you can get directly from your doctor

Note: Pre-authorisation does not automatically guarantee payment, but it secures a guarantee of payment if your procedure and codes fall within your specific policy benefits and table of limits. Always ensure you receive a confirmation reference number or letter for your records.

How to submit a claim

• Submit to Admin: Email all documents to claims@pamc.co.za (administered by Pan-African Managed Care - PAM)
• Specialist Claims: If you are claiming for a specialist, ensure you include a Specialist Referral Form completed by your designated network doctor, as their network partners must manage all out-of-hospital referrals
• Processing Time: Standard expense claims and refunds typically take between 5 to 14 days to be assessed, approved, and processed
• Deadlines: Ensure you submit your claim within four months of the treatment date; claims submitted after this period become "stale" and are generally rejected
• Support: For immediate queries, you can reach the Lion Health claims and support line directly at 087 405 2001 or 087 943 9612