Overview
Endoscopies – also called scopes – are used to investigate certain medical and surgical conditions like gastric ulcers, reflux, infections and abnormal growths.
You can have a scope done in your doctor’s rooms, in hospital as part of an approved admission or at a day clinic facility.
The attached document tells you how we fund scopes.
When we refer to scopes and how we cover them, we refer to diagnostic gastrointestinal scopes namely oesophagoscopy, gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy.
These are all used to investigate the digestive system.
The attached document also explains how we cover scopes that are done in-hospital, in a day clinic and scopes done in the doctor’s rooms, depending on your chosen plan.
It is important to call and tell us about your scope and get preauthorisation as soon as you know about it.
This is so you understand, depending on the procedure you’re having done and where the scope will be done, whether a co-payment or upfront amount will apply.
Please note that scopes used to investigate other body systems do not form part of this benefit and will be subject to your health plan benefits.