Everything you need to know about prior approval

If your surgery is within 5 days, you must call us on 0800 800 181.

You must contact us for prior approval if the cost of your healthcare service is likely to be over $1,000 or if you need to be hospitalised - including day stay or in-patient surgery regardless of the cost. You should do this at least five working days before the healthcare service being provided. After your healthcare service, send us your completed claim form along with the invoices.

If you don’t receive prior approval before the surgery/procedure you’ll need to pay the full costs yourself and then claim them back by completing a claim form and submitting original itemised receipts.

Apply online

You can apply for prior approval online through My Southern Cross. Applying online ensures we receive all the information we need to process your request quickly. It also ensures your personal information is protected because My Southern Cross is a secure website.

Log in to my Southern Cross to apply for prior approval online.
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Remember, if your surgery is within 5 days, you must call us on 0800 800 181. If your procedure is being performed by an Affiliated Provider, then the Provider can organise prior approval for you. Click here for more information on how this works.

Frequently asked questions that may help

What is prior approval?

Prior approval confirms whether your surgery/procedure is eligible for cover and the conditions that apply. You provide us with estimated charges from the health services provider and we then advise your level of cover.

What information do I need to provide when applying for prior approval?

When applying for prior approval, please fill in all the information requested on the form. It is very important you provide detailed information such as the name of the surgery/treatment, hospital/facility name, surgeon’s name and addresses. This will speed up the application process.

We will need a breakdown of the total procedure cost estimates (e.g. surgeon fee, anaesthetist fee, prosthesis, hospital costs). Your surgeon/specialist can provide this information to you. For some procedures we need written estimates. We’ll advise you if this is the case.

We may contact you if we have any questions.

How long will prior approval take?

We aim to send a prior approval letter to the policyholder within 3-5 working days. Sometimes we may need more information from you or the provider, so it may take a little longer.

If you require prior approval in under 5 working days, please call us.

How do I find out if a healthcare service is covered by my health insurance plan?

Your policy document outlines the healthcare services covered by your plan.

Click here for a list of policy documents.

If you have any further questions, please contact us on 0800 800 181.