Scheme finally sends claims-error-affected members the letter it ought to have a week ago.
Discovery Health’s abrupt about-turn where it will now cover the costs of a claims processing error was so utterly predictable.
There has been a flood of sustained pressure since it began notifying members about the error, which affected members on the five high-end Discovery Health Medical Scheme (DHMS) plans, at the start of January.
The administrator could not have handled this debacle more ham-fistedly if it tried.
Not only were the letters sent to members about the error nearly completely tone deaf – it referred to the mistake it made abstractly as an “error” that was “made” – they weren’t even dated!
Talk about amateur hour.
The letters were signed by chief operating officer of Discovery Health, Karen Sanderson, with the final line being the hardly sincere: “Thank you for your understanding as we make these corrections.”
Surely an error of this magnitude, regardless of it only affecting 0.6% of the scheme’s total membership, warranted communication from the CEO, Dr Ron Whelan?
ALSO READ: Discovery backs down after bullying its own members
Playing for time?
The timing of these letters also frustrated members.
Discovery had, at least according to the communication, reprocessed the affected claims “as at” 18 December.
But because communication was only sent in early January, members were unable to make changes to the plans they were on.
Much of this was grandstanding as they more likely than not wouldn’t have downgraded their cover, but the frustration and anger was clear.
ALSO READ: Discovery to cough up after major medication claims mistake
Passing the buck
The fatal error made by Discovery Health in those letters is that it accepted no real culpability for its error and made the amount owing the member’s problem.
While not included in the communication, in its other engagements with affected members, Discovery appears to have proposed a number of options to them, including agreeing to a payment plan, or having amounts deducted from reimbursements (such as refunds for doctor consults).
Another option apparently proposed – being handed over for debt collection.
Numbers, and complexities
We finally have a clear handle on how many are affected.
In Sunday’s statement where Discovery confirmed it would cover the costs of the claims overpayments; it says the error affected 16 507 members where the Above Threshold Benefit (or ATB, which is where these errors crept in) applies. This is not an insignificant number of people!
After being asked by News24 to “comment on an estimated overpayment figure of R250 million”, Discovery Health told the outlet the amount was “significantly less” than that. It is reasonable to suggest that it is between R50 million and R100 million.
In correspondence with some affected members, it quickly became clear to Moneyweb just how complex each of these errors is.
In numerous cases, members brought forward spending or procedures because they believed they had funds available.
How did Discovery Health think it was going to succeed in forcing members to pay it “back” for a pair of glasses they acquired, for example?
The second fatal error Discovery appears to have made is that it didn’t inform the Council for Medical Schemes (CMS) about the error. Whether it was legally required to is not clear.
In the CMS’s statement on the matter, it says “on 5 January 2026, the Council for Medical Schemes learnt of Discovery Health Medical Scheme’s alleged medicine claims processing errors via the media but received no formal complaint from the affected members of the medical scheme”.
Tellingly, the CMS doesn’t refer to any communication from the scheme.
ALSO READ: Discovery medical aid mistake to cost members thousands
Mea culpa (at last) and compassion (at last)
In its statement on Sunday, Discovery says: “Covering this cost is the right decision, one that reflects our commitment to fairness, integrity and putting members first, especially when we fall short.”
Had it started from a position of “fairness, integrity and putting members first” – especially since it did fall “short” – it might’ve found a very different response from affected members!
The letter sent to affected members on Sunday could not be more different to the original communication mess.
Firstly, it was from Whelan. Secondly, it was compassionate, contrite and written in plain English.
“I wanted to write to you personally about an important update regarding the system error that affected how certain medicine claims were processed from your Above Threshold Benefit (ATB) during 2025, inadvertently resulting in an overpayment of your claims.
“I am sorry that you were one of the members impacted.”
An actual real personal apology! It’s almost like the group’s communications professionals are back from leave.
ALSO READ: More than half of Discovery’s medical aid plans saw declines in members last year
“Ordinarily, when members’ claims are overpaid, the Scheme’s rules and industry regulations allow for those funds to be recovered, because the funds in the Scheme belong to all members. In line with these requirements, the recovery process began in December.
“However, after carefully listening to members’ concerns and considering their individual experiences and circumstances, Discovery Health has decided to cover the cost on members’ behalf, notwithstanding the validity of the recovery.
“This means you are not required to repay any monies related to this matter – and if you have already repaid this, it will be refunded,” he adds.
“Similarly, if this overpayment was offset against other payments due to you, those offset amounts will also be refunded to you.
“We apologise unreservedly to members affected by this error. Covering this cost is the right decision – one that reflects our commitment to fairness, integrity and putting members first, especially when we fall short.”
Had it simply started from this markedly different position little over a week ago, it might’ve earned a significant amount of unbuyable goodwill from its members and clients.
This article was republished from Moneyweb. Read the original here.