Discovery Health faces backlash as members hit with unexpected claims reprocessing fees

Members of Discovery Health have found themselves in a precarious financial position thanks to errors made by the medical scheme's Administrator when processing claims. The Motor Industry Staff Association (MISA) has voiced its condemnation of these misjudgments and insists that Discovery Health must assume the financial burden incurred by its members as a result.

MISA, representing over 75,000 members in the retail motor industry, labelled Discovery Health’s approach as "unacceptable" after it emerged that certain prescription and over-the-counter medication claims were incorrectly processed at higher rates than permitted. The errors have led to many members reaching their annual Above Threshold Benefit (ATB) sooner than expected, meaning claims have been funded incorrectly — much to the detriment of the members involved.

Martlé Keyter, Chief Executive Officer: Operations at MISA, expressed disbelief at the lack of accountability shown by the Discovery Group. "Discovery Health must take the financial knock on behalf of its members. It is not as though this is a bankrupt medical aid," she said. Keyter highlighted that the Discovery Group, a JSE-listed entity encompassing Discovery Health, Discovery Life, Discovery Invest, Discovery Insure, and Discovery Bank, reported impressive growth figures, with a 29% increase in normalised profit from operations to R15.21 billion by June 2023. The fact that affected members are now burdened with debts running into thousands of rand is both shocking and unsettling, according to Keyter.

Particularly affected are Discovery members on its five top plans – including Classic Comprehensive, Classic Priority and Executive.

The repercussions of Discovery Health's errors come at a time when the retail motor industry is still grappling with significant strain. Just last week, MISA disclosed that Motus Retail is facing a grim outlook heading into 2026, with 86 job losses and significant alterations to remuneration and benefits for hundreds of employees. The stress on financial resources is palpable, making the reprocessing of claims by Discovery Health all the more alarming for MISA’s members, many of whom rely on these medical benefits for their health and livelihood.

Discovery Health has since undertaken the task of reprocessing the impacted claims and reaching out to members, revealing that they now owe the scheme the value of the incorrectly funded claims. This processing error has left many members in considerable distress, with financial turmoil and uncertainty looming over their health futures.

As the situation continues to unfold, it remains to be seen how Discovery Health will address the grievances of its members and whether pressure from organisations like MISA will prompt any remedial action. The health of thousands who rely on these essential services now hangs precariously in the balance, raising serious questions about the responsibilities of medical aid administrators in safeguarding the interests of their members.