Discovery Health to foot bill for claims errors after member backlash

Stephen Grootes speaks to Mark Hyman, founder of MediCheck about Discovery’s decision to cover the costs of its error, providing a sense of relief for the clients who had been asked to pay it back.

Listen to the interview in the audio player below.

Discovery Health has reversed its stance on disputed medical aid claims and will now absorb the costs linked to claims processing errors, following widespread backlash from members and healthcare providers.

The move comes after policyholders raised concerns that they were being held financially responsible for overpayments caused by administrative or system errors beyond their control.

In some cases, members were reportedly asked to repay funds or faced shortfalls when Discovery sought to claw back amounts from healthcare providers.

Discovery Health confirmed that it would cover the costs associated with qualifying claims errors, effectively shielding members from financial exposure resulting from incorrect claims processing. The decision marks a significant concession by the country’s largest medical scheme administrator, amid growing scrutiny of billing practices and member protections in the healthcare funding sector.

While Discovery Health has not disclosed the full financial impact of the decision, absorbing claims overpayment costs could result in higher short-term administrative expenses. The medical scheme administrator says it is reviewing its internal systems and processes to reduce the likelihood of similar errors in future. 

Speaking to Stephen Grootes on The Money Show, Mark Hyman, founder of MediCheck says the incident serves as a reminder that operational missteps can quickly escalate into trust and governance issues, with financial and reputational consequences.

"Discovery had absolutely no right to this reported claw back...we were firmly of the opinion, and we still remain firmly of the opinion that error was an error from Discovery."

- Mark Hyman, founder of MediCheck

"We've received in excess of 1975 complaints from 16,000 members. Our calculation now that we have so much more information. We've been able to analyse it, and we've extrapolated the numbers and we estimate now that the actual figure involved is anywhere between R125 million-R140 million.

- Mark Hyman, founder of MediCheck

Scroll to the top of the article to listen to the full interview.