Understand when approval is required, how claims are handled and what members and providers must do.
Pre-authorisation helps confirm eligibility, clinical need, plan benefits, provider status and cost rules before selected services are delivered
Admissions, surgeries, advanced diagnostics, specialist referrals, emergency admissions after stabilisation, chronic-care programmes, high-cost medicines and selected procedures may require approval.
Use eligible providers, present your ID, follow referral and authorisation rules, provide accurate information and contact LifeCome support if unclear.
Verify membership, submit clinical notes where required, obtain authorisation before eligible services and submit complete claims documentation.
LifeCome HMO reviews claims for eligibility, documentation, tariff compliance, duplicate billing, fraud indicators and plan rules.
Out-of-pocket reimbursement, where applicable, is subject to prior rules, documentation, approval and benefit limits. Members should avoid self-paying without guidance unless urgent circumstances require it.