Johannesburg – Following the publication of South Africans speak out on Discovery non-payment struggles, Town Press has received further correspondence from members detailing alleged refusals of authorisation and prolonged disputes involving Discovery Health Medical Scheme, raising renewed concerns about access to care and dispute resolution within the private healthcare system.
One of the accounts comes from a long-standing Discovery member who says she was denied authorisation for a breast biopsy in September 2025, despite presenting with a painful breast lump, abnormal mammogram results and blood tests indicating infection. According to her account, hospital staff were initially reluctant to admit her once the condition was identified as breast-related, citing difficulties obtaining approval from the scheme.
After being admitted and placed on intravenous antibiotics, the member says repeated clinical motivations for theatre authorisation were declined. She was ultimately discharged without the procedure being performed. Concerned about the risks of delay, her surgeon reportedly carried out the biopsy in his consulting rooms under local anaesthetic, a procedure she says should ordinarily have been done under general anaesthetic in theatre.
She describes severe pain during and after the procedure, followed by ongoing wound care, drainage and persistent discomfort weeks later. “When I needed my medical aid the most, they were not there for me despite the severity of my case,” she wrote, adding that she has since decided to cancel her membership and report the matter to the Medical Ombudsman.
A second submission, from another Discovery member, details a prolonged dispute relating to an orthopaedic condition and subsequent engagement with the Council for Medical Schemes. The member alleges that appeals were mishandled, documentation was not properly reviewed and correspondence from legal representatives went unanswered. He further claims that a settlement proposal made by Discovery would have required payment of premiums for periods during which no cover would apply, an offer he rejected.
The correspondence also raises broader concerns about the balance of power between large medical schemes and individual members, questioning whether current complaint and appeal mechanisms adequately protect patients, particularly when cases escalate to regulatory or legal processes.
Both individuals have indicated their willingness to be interviewed and have submitted supporting documentation, including clinical reports and correspondence, for review.
Correspondence from the Ministry of Health indicates that Discovery features prominently in complaints relating to non-payment of claims, with members raising concerns about delays in compensation, extensive legal contestation and a high number of claims that remain unapproved.
Discovery Health has not yet responded to Town Press’ questions relating to these specific cases. The scheme has previously stated that claims decisions are made in line with scheme rules and clinical protocols, and that members have the right to appeal decisions through internal processes and the Council for Medical Schemes.
These latest accounts add to a growing body of complaints from South Africans who say they are struggling to secure timely authorisation and reimbursement for medically necessary care, highlighting renewed calls for greater transparency, accountability and patient-centred reform within the medical aid sector.
Anyone with additional information relating to this story can contact us through email press@townpress.co.za
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