Discovery Health meets MediCheck over claims repayment dispute
Discovery Health officials have met with a medical claims assistance company handling the cases of medical aid scheme members who were asked to repay money paid out in error.
Discovery says a system glitch caused some over-the-counter and prescription medicine claims to be paid in full, contrary to specific plan rules.
Discovery Health has since contacted affected members asking them to repay the money.
More than one thousand affected members have contacted Mark Hyman from MediCheck.
He says they consulted lawyers and sent a demand letter to Discovery Health, the scheme’s administrator.
Hyman says they had a positive meeting with Discovery on Thursday.
" They were very open and honest as to what had happened. They put their point of view across. We went back to them during the course of the meeting, and we advised them as to what we believe should be happening. We were saying why should the members bear the brunt? The actual party that created the error should bear the cost.
"It shouldn't be just asked of members. The member doesn't have a contract with the administrator. The member has a contract with the medical scheme. Now the administrator was at fault. They made an error. It has gone back to January 2025."
Discovery Health says the recoveries are being handled in line with the Medical Schemes Act, the rules of the Council for Medical Schemes, and its own scheme rules.
In a statement, the Council for Medical Schemes says the Act allows for the recovery of funds that have been paid to a member, to which that member may not have been entitled.
It states that, as a general principle, a scheme is expected to establish clear parameters for recoveries and deductions to properly govern the process.
However, Hyman says there is a problem.
"The Act quite clearly says that if there is an error in payment, the medical aid has 30 days in which if they paid a member in which to send the member an advice, the claim is being reversed and the member has 60 days within which to respond.
“That hasn't been followed by virtue of the fact that this goes back 12 months. So how would the member know that they had been enriched?"
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