Discovery Health's systems hiccup turned routine claims into nasty 'you owe us' notices for 16,507 members, with some demands climbing toward R80,000. After MediCheck lit the fuse and the Council for Medical Schemes began asking questions, Discovery has backtracked, promising refunds and no 2026 benefit pain, but questions remain about governance, controls and accountability.

The Council for Medical Schemes plans to investigate the processes that led to an error in Discovery Health Medical Scheme's administration - resulting in 16,507 members suddenly being told that they owed the scheme significant amounts of money, up to as much as R80,000.

MediCheck, an independent medical scheme advocacy firm that assists members in disputes with medical schemes, estimates the total value of disputed recoveries to be between R130-million and R170-million, based on the number of affected members and the range of individual recovery amounts reported.

However, Discovery Health placed the value at about R125-million, equivalent to around 0.1% of annual Discovery Health Medical Scheme (DHMS) claims. About R3.6bn in benefits was paid out for the affected members over the course of last year, chief executive Dr Ron Whelan told Cape Talk last week Tuesday.

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Discovery Health told Daily Maverick that the error originated after a system update in early 2025, and related to how certain medicine claims (over-the-counter medicine, non-preferentially priced medicine and ethical medicine), accumulated to the Annual Threshold and were paid from the Above Threshold Benefit (ATB). As a result, members reached their ATB thresholds faster, which inadvertently resulted in the scheme paying for some medicines...