Discovery Health to cover claims error costs after member outcry
Discovery Health will absorb the costs related to its recent ATB error.
Image: Independent Media
Discovery Health clients can breathe a sigh of relief following the news that the medical scheme will be covering the costs associated with a claims system error that caused much distress among clients last week.
Discovery announced on Sunday that members affected by a system gremlin that resulted in the overpayment of certain Above Threshold Benefit (ATB) claims during 2025 would no longer be required to repay any amounts related to this error.
According to the medical scheme, the error affected a limited group of members whose ATB claims were inadvertently overpaid last year.
"Notwithstanding the validity of the recovery, having carefully listened to members’ concerns and considered their individual experiences and circumstances, Discovery Health has decided to cover the cost on members’ behalf," Discovery CEO Ron Whelan said.
“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,” he added.
The claim statements for those affected will be updated to reflect the newly announced decision, Discovery said, and any deductions made to Medical Savings Accounts, Personal Health Fund or HealthPay accounts will be reinstated.
Members who have already repaid amounts will be repaid in full.
Furthermore, the medical aid provider said it has set up a dedicated service team to contact affected members directly, in order to address any outstanding queries and provide clarity.
The error affected 16,507 members across certain Executive, Comprehensive and Priority plans, Discovery said, and affected around 10.5% of members on those plans. This is less than 0.6% of the scheme’s total membership, it said.
As IOL reported last week, some members were asked to repay amounts incorrectly funded from the ATB, with some reports on social media indicating amounts of around R35,000. This caused a stir on social media as members felt it was unfair to be handed unexpected costs due to errors made by the medical aid provider.
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