Discovery Health must pay for its mistakes, says MISA

Discovery Health’s members should not bear the brunt for mistakes the Administrator made when processing the claims of its members, according to MISA, the Motor Industry Staff Association.

The organisation said in a statement that believes it is unacceptable that Discovery Health thinks it can just dump affected members in financial turmoil overnight and walk away with its profits.

Discovery Health Medical Scheme has sent communication to about 0.6% of its members requesting them to repay co-payments after a processing error saw claims incorrectly paid out at a higher rate than their plan's benefits allow. Media reports suggest Discovery is claiming as much as R22 000, R25 000 and R37 000 back from some of its members.

The error is related to the Above Threshold Benefit (ATB) on the Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority and Essential Priority plans. The claims appear substantial considering annual contributions for a main member on the Classic Comprehensive scheme amounts to about R83 700 respectively.

MISA said, “Discovery Health must take the financial knock on behalf of its members. It is not as though this is a bankrupt medical aid. The Discovery Group, a JSE-listed company, comprises of Discovery Health, Discovery Life, Discovery Invest, Discovery Insure and Discovery Bank.

Martlé Keyter, MISA’s CEO Operations, said, “In September last year the Discovery Group grew its normalised profit from operations by 29% to R15.21 billion in the year to the end of June, with Vitality’s profit from operations up by 70% to R3.205 billion and Discovery South Africa’s profit rising by 22% to R12 billion. It is shocking that Discovery Health even sent the letters of the “error” it made to affected members."

MISA is the majority trade union in the retail motor industry representing more than 75 000 members. Thousands of MISA members working at dealership groups are members of Discovery Health.

Discovery Health has since reprocessed the affected claims and contacted impacted members, informing them that they now owe the scheme the value of those incorrect payments. In some cases, the amounts run into tens of thousands of rand.

Last week the Council for Medical Schemes (CMS) said it will investigate claims that Discovery Health Medical Scheme is seeking to claim co-payments back from its members due to an error at South Africa's biggest medical aid in December.

The CMS said it had received no formal complaints from Discovery Health's members who had alleged claims processing errors, but Medicheck, a consumer health advocacy organisation in South Africa, had subsequently lodged a concern with the regulator.

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