Claims Hound

20/08/2026

Hospital invoices patient for a shortfall of R43 031,99, despite being treated at a Designated Service Provider (DSP) facility, obtaining prior authorisation from his medical scheme for the treatment and the prosthesis to be used.

Our client, a very well-informed medical specialist himself, needed to have spinal surgery.

He contacted his medical scheme, and they approved the procedure at a private hospital within their network.

The prosthesis was quoted at R20 004,16, while his medical scheme benefit option covered R18 491.

He accepted the R1 513,16 prosthesis shortfall and was told there would be no hospital tariff shortfall because the hospital had an agreement with the scheme and would charge the scheme’s rates.

Unfortunately, the patient received only a high-level hospital account, which lacked enough detail to identify the specific items that had been underpaid or not paid.

After some struggles, a detailed account was obtained and the discrepancies between what his medical scheme paid and what the hospital wanted to get paid could be pinpointed.

We believe that the primary function of the Protection of Private Information Act (POPIA) is to make it very difficult for patients and members of medical schemes to obtain their own information. It also makes it more difficult for mandated professionals to act on their behalf.

It was established, that the Network Hospital, with whom the medical scheme has a contract, used the INCORRECT tariff structure when invoicing the patient!

Once this was corrected the outstanding balance was reduced from R43 031,99 to R16 988,19.

The Network Hospital overcharged the patient by R26 043,80 on tariffs!

What is truly frightening is that the Medical Scheme did NOT pick up that their Network Hospital was overcharging the patient. Surely their systems MUST be able to do so?

Had it been a smaller amount the patient may simply have paid the hospital and been blissfully unaware that he had been overcharged.

We believe our followers will agree that the scheme should audit invoices from this hospital, and possibly all hospitals in the group, AND assist members who have been overcharged to recover their money from the hospital group. They have the information readily available on their systems.

According to his medical scheme the remaining outstanding amount of R16 988 was in respect of RADIATION GLOVES which they don’t pay for.

Unfortunately, the hospital has not responded to Claims Hound regarding what makes up the shortfall, and we advised the patient to ask the treating surgeon whether the gloves were necessary and used during the operation.

The patient unfortunately doesn’t know, as he was unconscious at the time.

Our research indicates that Radiation gloves are used in spinal surgery to shield the surgeon’s hands from harmful scatter radiation generated by continuous X-ray imaging during complex spinal procedures.

Perhaps his medical scheme should be paying for radiation gloves, at REASONABLE cost, in such events.

The cost of the specific gloves used, ProGuard X-Guard RR1 (Size 9.0) is indicated as between US$200 and US$255 for a box of 5 pairs, before import duties. At R16,13 to the US$ this is R4 113,15 for 5 pairs.

Looks like there MAY be some profit margins involved?

To date, we have not had any further feedback from the patient, the hospital or the medical scheme and have closed our file in this matter.

We hope that an agreement was reached between the parties, in terms of which the outstanding amount was either written off, paid by the medical scheme or at least discounted.

ALWAYS obtain a DETAILED statement of account from the hospital.

It enables you to reconcile your Medical Scheme Claims Statement.

Do NOT simply pay shortfalls on hospital accounts.

Harness you inner Claims Hound and investigate why they are there!

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12/08/2026

Two cancer patients, both with unpaid pathology claims — one administered by Discovery Health (Pty) Ltd and the other by Momentum Health (Pty) Ltd. Yet their experiences were decidedly different!

Cancer treatment places immense emotional, physical and financial strain on patients and their families. In our opinion, one would expect medical schemes and their administrators to handle these cases supportively, minimise red tape, and avoid creating any further burdens for their members.

The cancer treatments in both these cases were approved and provided by Designated Service Providers (DSPs) of the respective schemes.

Since the treating doctors were DSPs, one would reasonably expect that the treatment provided would fall within the parameters and protocols of the Medical Schemes. AND, if the required treatments were wide of these, the DSP would obtain the necessary approval from the schemes

In both cases, the treating doctors ordered pathology tests that their respective medical schemes did not pay for, despite the doctors being scheme DSPs.

PATIENTS generally have NO control over the Pathology tests requested by the treating doctors. When we are seriously ill, exhausted by tests and treatments, we have to place our trust in our doctors.

a. The Wooltru Healthcare Fund administered by Momentum Health (Pty) Ltd experience.

The frail, elderly patient, or rather her emotionally exhausted family, was VIGOROUSLY pursued by Pathcare for R3 712,00 in unpaid pathology claims that were requested during her cancer treatment.

Claims Hound contacted Pathcare, requesting copies of the invoices relating to the short payments.

Pathcare agreed to suspend their debt collection process, affording Claims Hound some time to engage with the medical scheme without harassing the patient.

Claims Hound contacted the Principal Officer of Wooltru Health Care Fund and requested that the reasons for the short payments be investigated and that the outstanding amounts be paid as Prescribed Minimum Benefits (PMBs), in full, since the services were provided by a DSP.

Momentum Health (Pty) Ltd, the administrator of the scheme, advised that they were investigating the matter and immediately engaged with the service providers concerned.

They had all the necessary information at hand since they had processed the invoices for the service providers involved.

Three days later Momentum Health (Pty) Ltd advised that their review was completed and that the outstanding amounts would be paid to Pathcare, in full at their next claims payment run.

b. The Discovery Health Medical Scheme administered by Discovery Health (Pty) Ltd experience.

Lancet aggressively pursued the patient’s wife — and later widow — for an unpaid balance of R2 123,30 for pathology services requested by the treating oncologist.

The oncologist was a Discovery Designated Service Provider (DSP) and a member of the ICON oncology group used by Discovery as consultants for cancer treatments.

The extremely unwell patient was registered on the Discovery Oncology / Advanced Illness Benefit (AIB) program for cancer treatment.

Claims Hound asked Lancet for copies of the short-paid invoices and to suspend debt collection while it engaged with Discovery Health Medical Scheme.

Lancet provided the copies of the invoices and agreed to suspend their debt collection process.

Unfortunately, the debt collection process was NOT suspended and the harassment of the patient’s physically and mentally exhausted wife continued unabated.

At this time, his wife was his sole carer.

According to the Discovery Health Member Claim Statements the reason for the short payment was:

“You reached the Above Threshold Benefit limit. We will not pay further out of hospital claims.” (reason code 198)

Claims Hound emailed the Discovery Advanced Illness Benefit team, attaching the relevant Lancet invoices and Discovery Claims Transaction History.

We asked them to review the short payments because the treatment was for a Prescribed Minimum Benefit (PMB) condition and both the requesting and testing providers were Discovery DSPs.

Discovery responded almost immediately:

“Kindly note that the claims short-paid from the Oncology Benefit due to no authorisation for the pathology codes. The member’s healthcare provider may request for authorisation by submitting the treatment plan to [email protected]. This will be subject to Case Management review”

The reason provided was VERY DIFFERENT from the reason reflected on the Discovery Health Member Claim Statement!

Up to this point the member was NOT made aware that the treatment could qualify for payment if the treating doctor requested authorisation and provided an appropriate motivation!
We believe this is a SERIOUS programming error by Discovery Health (Pty) Ltd:

The reason code on the Member Claim Statement does not reflect the true reason for the short payment and, MORE IMPORTANTLY, the member is not told that the treatment may qualify for payment if supported by an appropriate motivation.

How many unsuspecting members are being robbed of their benefits in this manner!

Claims Hound escalated the matter to Discovery Health (Pty) Ltd’s executive office and copied the Principal Officer of the INDEPENDENT Discovery Health Medical Scheme in the correspondence.

In short, Discovery Health Medical Scheme was asked to contact its DSP and clarify why the non-qualifying pathology tests had been requested.

If the tests were found to be appropriate, Discovery was asked to pay Lancet.

If Discovery found the tests inappropriate, we asked them to insist that the treating doctor — its DSP — pay Lancet for ordering them.
It should be remembered that the DSP requested these tests, not the patient!

It would be reasonable for the patient to expect that services provided by a DSP for a PMB would be covered in FULL by the medical scheme.

It was further pointed out that Discovery expected the treating doctor to provide a motivation so that another doctor, the pathologist, could be paid.

Claims Hound asked whether Discovery would pay for this motivation?

For some reason they failed to respond to that question!
It is our understanding, from the Council for Medical Schemes Code of Conduct, that the scheme should pay the doctor for this not insignificant administrative work.

Claims Hound then sent an email to the treating oncologist requesting that they provide a letter of motivation for the tests DIRECTLY to Discovery so that they do not run afoul of the POPIA legislation.

The specialist oncologist was very helpful and sent a letter of motivation to Discovery.

Unbelievably, they advised that they had reviewed the letter of motivation, provided by THEIR DSP, and found it to be INCOMPLETE. The motivation did not sufficiently outline the clinical indication, presenting symptoms, or rationale linking the tests to the diagnosis and treatment!

This is fascinating considering that Discovery Health (Pty) Ltd views the function of their Medical Advisors as:

“Our Medical Advisors do not provide clinical opinions or guidance on how the member should be treated, as treatment decisions rest entirely with the treating doctor. Their role is to assess applications in accordance with Scheme Rules, plan benefits, clinical entry criteria, and PMB regulations.”

Incidentally, we do not know who these “Medical Advisors” are, what their qualifications are or what their opinions are since these are not provided. (are they nurse practitioners or medical specialists)

Discovery then did the most remarkable thing!

They ACTUALLY contacted the treating service providers and concluded that all but R125,28 of the amounts owed to Lancet was payable.

Claims Hound contacted Lancet and they agreed to write off the outstanding balance.

Claims Hound asked that Discovery Health Medical Scheme reviews the process followed by their administrator, Discovery Health (Pty) Ltd, from an ETHICAL, member perspective.

We do not believe that the INDEPENDENT medical scheme, Discovery Health, reviewed anything!

Instead, their Administrator, Discovery Health (Pty) Ltd, advised that they were satisfied with their conduct and the processes followed. Nothing better than investing your own conduct and concluding you did well.

Perhaps most telling is their view regarding the need to engage with their OWN DSPs.

“There is no requirement for Discovery to proactively engage network providers beyond the approval communication issued at the time of oncology registration. This communication clearly outlines the approved treatment, PMB cover, and the process to follow where additional tests or services outside the basket of care are clinically required.

Where this process is not followed, claims are submitted without prior review and are processed accordingly. This necessitates a retrospective review once additional information is provided.”

The response is however not surprising since this is the same Discovery Health (Pty) Ltd that ATTEMPTED to recover the costs of a pharmacy processing error, MADE BY THEM, from the members of the INDEPENDENT Discovery Health Medical Scheme in 2025.

Similarly, the INDEPENDENT Discovery Health Medical Scheme did not prevent them from doing so at the time.

What prevented them was a major public outcry and legal pressure.
Perhaps the legal pressure should have come from Discovery Health Medical Scheme prior to their Administrator sending nasty letters to the scheme’s members?

In this case, these extra-ordinary theatrics that Discovery performed to make it difficult for their member to claim his PMB benefits, is truly remarkable. (Perhaps this is an isolated case?)

Surely the cost of this theatre production far exceeded the costs of doing the ETHICAL thing and contacting your OWN DSPs in the first instance? (Discovery ended up contacting the DSPs in any event.)

We encourage members to NOT simply pay their outstanding Pathology bills but to challenge their medical schemes for non-payment, especially in the case of PMBs.

Have you had a similar experience? Or even worse, did your medical scheme use your Medical Savings Account (MSA) funds to pay for your PMBs.

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02/08/2026

The Discovery Health Active Smart Plan seems to be an EXCELLENT option for OLDER people with CHORONIC conditions to get their Prescribed Minimum Benefits (PMBs) in the Private Sector paid in full for only R1 350 per month. As an OPEN medical scheme, Discovery CANNOT stop you from joining the scheme or the option!

Dr Ron Whelan, CEO of Discovery Healthy (Pty) Ltd stated at the Discovery Health Medical Scheme AGM that the Active Smart Plan was for young professional and that the Discovery “Army of Advisors” would sell it to that market.

He seems to have FORGOTTEN that Discovery Health Medical Scheme is an OPEN medical scheme and that ANY qualifying applicant must be admitted.

If you are currently a member of another medical scheme and have had continuous membership for the past 24 months, then you can join the Discovery Active Smart Plan WITHOUT any GENERAL WAITING PERIODS or CONDITION SPECIFIC EXCLUSIONS being applied to any PMB treatment. (Per Regulation 8 to the Medical Schemes Act)

What a bargain!

Let’s look at the PMB treatment basket for a for a patient with DIABETES Mellitus Type 2, High Cholesterol and ASTHMA over a 12-month period.

Doctors’ consultations (3), Flow volume tests (6), Nebulisation in-rooms (2), Chest X-rays (1), Ophthalmology consultations and related treatments (2), Pathology tests (multiple), Dietician consultations (1), Podiatry consultations (2), Monthly Chronic Medication (Multiple)

The cost of treating your PMB Chronic Conditions alone exceeds the total annual contribution (R16 200) of the Discovery Active Smart Plan.

Included in PMBs are:
- medical emergencies
- 271 medical conditions (Defined as Diagnostic Treatment Pairs)
- 26 chronic conditions (Defined in the Chronic Disease List)

You can see exactly what your entitlement is on The Council for Medical Schemes website:

https://www.medicalschemes.co.za/resources/pmb/

Included here you will find heart attacks, strokes, embolisms and deep vein thromboses, typical things that happen to older people.

Even if Discovery Health ONLY pays for PMB treatment during the first 12 months of your membership it may be well worth your while joining the Discovery Active Smart Plan!

You can download the Discovery Active Smart Plan from the internet using any search engine, for example GOOGLE. (They want young people to find it)

Discovery seems to have also forgotten that old people are able to use the internet and surprisingly also Facebook.

Although the Discovery marketing campaign appears to be designed to make it difficult for older and people with chronic conditions to join the Active Smart Plan we believe this can easily be overcome if you bypass their “Army of Advisors” and email your application for membership directly to the scheme.

Despite the fact that section 24 (2) (e) of the Medical Schemes Act states that a medical scheme may not unfairly discriminate, directly or indirectly against any person based among other things on AGE, STATE OF HEALTH and PREGNANCY, this is exactly what Discovery Health seems to be doing in the Marketing of the Discovery Health Active Smart Plan. (But perhaps they are just inside the parameters of what they are allowed to do or rather get away with.)

To illustrate how they do this we will guide you through their Facebook campaign.

You can access the Discovery FB add at the below link:

https://www.facebook.com/share/p/1Eo9HXroyu/

We added screenshots of the various stages of the process on our website for your convenience and in case the Discovery link stops working:

https://www.claimshound.co.za/current-issues/

• The advertisement starts with Discovery inviting you to: “Switch to Discovery Health Medical Schem with no waiting periods for qualifying members – just 1 simple question.”

• It then states that you will have UNLIMITED GP consults and offers you The Active Smart Plan from only R1350 per month.

• It states that you need to answer, “Only one question to join” and provides a button to click called “See details”.

• You are then taken to a Discovery Health Webpage where you are required to fill out some details and answer a couple of questions, rather than one and then to click on a “CALL ME BACK“ button.

You MUST enter your name, last name, cell phone number and most importantly your ID number.

Your ID number enables Discovery to know how OLD you are!

• You are then required to answer the following question by selecting YES or NO from a drop-down list.

“In the past 12 months, have you or any of your dependants been admitted to hospital, or do you reasonably expect or plan to be hospitalised (including for pregnancy) in the next 12 months; and/or are you currently taking regular ongoing medication or receiving treatment for a medical condition or symptom?”

• Lastly you are required to confirm that you have had 24 months of continuous medical scheme coverage.

And then you can click the call me back button.

• One of our elderly staff members with several PMB Chronic Conditions went through the process and a week later still has not received a CALL ME BACK.

We suspect that a CALL BACK is not going to happen because the Discovery System may be programmed to only do call backs if the applicant is young, have no chronic ailments, had not been admitted to hospital in the last 12 months, do not anticipate going to hospital in the next 12 months, are NOT pregnant and have belonged to a medical scheme for the past 24 months.

• According to the Discovery offer it seems that you can: “For a limited time, join Discovery Health Medical Scheme with no waiting periods by answering just one simple question", is conditional on:

- Your age being within their target market (20 to 29), although we suspect that 35 will also be fine.

- That you answer no to their simple question relating to your health, hospitalisation and pregnancy.

This may be in breach of the legislation in terms of which they may NOT discriminate based on age, gender or state of health. (Men cannot get pregnant)

• Most IMPORTANTLY the offer they made for you to Switch to Discovery Health Medial Scheme appears to NOT depend on the answer you give.

As long as you answered their ONE question you appear to qualify to join the scheme without a waiting period.

This however is contradicted by some other adds they are running on the internet, screenshots of which we have added to the Claims Hound website.

https://www.claimshound.co.za/current-issues/

HOW TO BYPASS THE INTERNET SCREENED APPLICATION PROCESS:

1. Get a copy of the Discovery Health Medical Scheme Application Form.

- You can search for it on the internet and download the form. (Strangely we could not find a copy on the Discovery website but perhaps we are just not good at these things)

- Download one from the Claims Hound website.

https://www.claimshound.co.za/current-issues/

- Send an e-mail to [email protected] and ask them to send you a copy.

2. Complete the form and e-mail it to [email protected]

Remember to disclose the circumcision you had in 1963 as previous medical treatment on the form so that it cannot be used to cancel your membership based on non-disclosure later.

3. If you are experiencing any difficulties, get blocked or ignored during the application process we suggest that you lodge a formal complaint to the Principal Officer of Discovery Health Medical Scheme at [email protected] which is the email address provided in the product brochure.

For some reason the Council for Medical Schemes has a different the e-mail address:

[email protected]

Best of luck with your application if you decide that the Active Smart Plan is for you.

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Current Issues Discovery Health International Travel Benefits Life Healthcare re GEMS Tanzanite One Option 2026.01.19 Discovery Health 2026 Increases per Moneyweb Flexicare Retail Brochure 2025 Discovery Trauma Cover Retail Brochure 2025 Stratum 2025 first time cancer diagnosis benefit guide

23/07/2026

Both the DENTIST and the PATIENT are now out of pocket because they failed to read and pay close attention to the details of the medical scheme’s authorisation.

Our client, who lives in a small town, needed extensive dental treatment and consulted the dentist he had used for many years.

Like many of us, he had some budgetary constraints when it comes to dentistry, but he wanted the best possible treatment and the best possible smile.

His dentist kindly agreed to engage with his medical scheme to establish exactly what they were prepared to pay for.

Ideally, he wanted to do three implants, but his patient’s benefit option provided only R7 700 PER FAMILY per year for implants—far too little to cover even one implant!

However, about R20 000 in benefits was available for dental work if he chose to do two crowns and a bridge instead of implants, provided the medical scheme approved the treatment before it was done.

The dentist submitted a detailed quote to DENIS, the company appointed by the medical scheme to assess dental work and help reduce unnecessary treatment and prevent fraudulent claims.

He requested approval for R19 810,50, and on 10 March 2026 the scheme approved R17 444,50, based on the funds available at the time.

Importantly, the authorisation letter stated that, “Claims are covered at the Scheme Dental Tariffs and are payable from the Day-to Day Limit, subject to the available limit AT THE TIME OF PROCESSING THE CLAIM.”

By now, our seasoned readers are exchanging worried glances!
The dentist’s receptionist informed the patient that, except for R2 366 which he needed to pay prior to the procedure, his scheme would cover the cost of the treatment.

He was happy with this, and the work was scheduled for 13 April 2026, a little over a month later.

He arrived at the practice on 13 April 2026, confirmed that R2 366 was payable, and paid the amount by credit card.

He made himself comfortable in the dentist’s chair, knowing that the dentist would invoice his medical scheme directly and there was nothing for him to be concerned about.

To the dentist’s shock and utter horror, the medical scheme did not pay R10 289,49 of the claim!

The patient was sent a statement requesting payment of the outstanding amount.

Extremely upset, despite his great new smile, he contacted Claims Hound.

We emailed the dentist to explain that our client had agreed to the treatment on the understanding that he would pay only R2 366.

There was no doubt that there was an agreement, as the patient confirmed and paid the R2 366 on 13 April 2026 before the treatment was performed.

The dentist’s reception then sent Claims Hound a copy of the scheme’s approval letter and stated that the patient was responsible for any amount the scheme did not pay
In response, Claims Hound asked for a copy of the consent form or agreement confirming that the patient had accepted responsibility for any amounts not paid by his medical scheme.

We have not yet received such a document, and it appears that one may not exist.

The dentist said he would meet with the patient to try to reach an amicable agreement.

Fortunately, both the dentist and the patient were reasonable people with a long-standing relationship, and an agreement was reached.

The dentist provided a substantial discount and the patient agreed to settle the discounted amount over an agreed period.

What can our readers take away from this cautionary tale?

Some key considerations for the Dentist / Doctor:

• Ensure that the patient signs a TREATMENT CONSENT FORM that clearly states the patient is responsible for any amount not paid by the medical scheme.

• Where authorisations are subject to available benefits at processing time, the work AND invoicing MUST be done as soon as possible after the benefit approval date.

In this case, approval was obtained on 10 March 2026, the work done on 13 April 2026 and the claim processed on 20 April 2026.

This left 41 days during which ANY claims submitted in respect of ANY beneficiary on the scheme against the Day-to-Day Limit would have reduced the amount available to pay the dentist.

• Send a copy of the Authorisation to the Patient by e-mail and highlight the section that states “subject to available benefits at the time of processing”.

• When there is a short payment by the medical scheme, personally engage with the patient as soon as possible in an AMICABLE manner and DO NOT allow your RECEPTIONIST or ACCOUNTANT to start the conversation with a “WE DEMAND” attitude.

The goal is to keep the patient, avoid negative publicity, and recover as much of the outstanding amount as possible as quickly as possible.

Key considerations for the Member/Patient:

• Get a detailed quote, in writing, for the work to be done.

• Request a copy of the Authorisation provided by your medical scheme.

• Check how much of the day-to-day limit is available shortly before the work is done so that you have a clear idea of how much you are going to be liable for.

• Check your medical scheme claims correspondence carefully to see how they have processed the claim and anticipate receiving a statement from the service provider for any short payments.

• Do NOT blindly enter into acknowledgement of debt or settlement agreements with the service provider and/or their agents:

- Inform the service provider that you cannot afford to pay the outstanding amount and ask for a discount.

- If a discount is offered that is acceptable to you, then either settle it as a once-off amount or offer to settle the outstanding amount in instalments THAT ARE AFFORDABLE to you.

- If the service provider does NOT accept your settlement offer, then simply inform them that it is all you can afford and MAKE the payments according to your offer. (Remember that it is not possible to pay money that you do not have.)

- Depending on how the service provider reacts, you may want to do a social media post on your good, bad or terrible experience and INCLUDE the name of the doctor in the post.

(If you enjoy your liberty, make sure your facts are ABSOLUTELY correct!)

Once you do this, AI (Artificial Intelligence) may pick it up and add it to the broader pool of online information.

When someone searches online to see whether the doctor is reputable, this information may be included in the AI response. If many people report positive experiences, AI is more likely to generate a favourable response.

To see how this works:

Select the AI mode in GOOGLE and ask: How do members rate Discovery Health?

The response we got was:

“Members rate Discovery Health with an average score of 4.4 out of 5 stars in broad customer satisfaction surveys, and it ranks as the industry leader in the 2025 Medical Aid Customer Experience Index. However, public consumer forums like Hellopeter show a much lower Trust Index score of 2.5 out of 5 stars, which is common for medical schemes due to high complaint volumes regarding claims.”

Please share your experiences with us, we would love to hear from you and how you dealt with a similar situation!

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09/07/2026

Do NOT wait until you are in the Intensive Care Unit (ICU) before APPOINTING someone else to interact on your behalf with your Medical Scheme. It is important to do so while you CAN.

The person you appoint can be a family member, spouse, friend or legal entity. In fact, any competent natural or legal person of YOUR choice.

Perhaps you should consider appointing more than one.

To understand why this matters – and how easy or difficult some medical schemes make the process – consider the following:

Your elderly spinster aunt is in hospital, and you urgently need a Consent Form from her medical scheme so you can help her with authorisations and claims.

Unfortunately, she does not have online member access to her medical scheme and neither do you.

Fortunately, she belongs to Bestmed, whose website lets you access the “CONSENT FOR SHARING PERSONAL INFORMATION FORM” without logging in – you don’t need to be a member.

You can complete the form online, print it, and take it to your aunt in hospital to sign when she has a good moment. Alternatively, you can download it to one of your electronic devices and get it signed digitally.

Once signed, simply email it, together with the required ID copies, to the email address provided on the form.

We now challenge you to get a copy of the Discovery “PERMISSION TO MAKE CERTAIN INFORMATION AVAILABLE TO A THIRD PARTY 2026” form as a non-member, or even as a member.

You will find that Discovery Health Medical Scheme does not have its own website! The Discovery Health Medical Scheme has to be accessed via the Discovery Ltd website, even though the medical scheme is NOT part of the Discovery Group.

Search links labelled “Discovery Health Medical Scheme” take you to the Discovery Ltd website, where the Medical Aid link appears under the “INDIVIDUALS” section.

In the “GET HELP” section you will find a link called “FIND DOCUMENTS AND CERTIFICATES”.

Surprisingly, even though this form is listed under “Consent Application” it is not available for download there.

You must click on a link that asks you to sign in as a Discovery member – which means your spinster aunt and you are unable to access the Consent Form!

It appears that Discovery does not consider it important for you or your family to have immediate, unrestricted access to this form?

Discovery Health (Pty) Ltd is another possible contact point for obtaining this special and elusive form.

They can be contacted by Telephone (members): 0860 99 88 77, Telephone (health partners): 0860 44 55 66, or via WhatsApp 0860 756 756.

We also found three suggested email addresses that may help in obtaining this form in the Discovery literature:

[email protected]
[email protected]
[email protected]

We invite readers to take up the challenge to get this form using these channels and share their experiences.

In 2025, we raised concerns about the CONTENT of Discovery’s “PERMISSION TO MAKE CERTAIN INFORMATION AVAILABLE TO A THIRD PARTY 2025” form, which resulted in Discovery not having a 2026 version available for us to use because they were reviewing the form.

Discovery agreed that we could continue using the 2025 version of the form so that we could represent our clients.

This worked well until 27 May 2026, although we still found some of the content objectionable from a medical scheme member’s perspective.

After significant effort by us and our nearly blind 80-year-old client, a 2025 form was completed and signed, only to be told that Discovery could not investigate the matter unless we complete a 2026 form instead (Which we did not have).

Following objections by us, the Discovery Compliance Department graciously accepted the 2025 form as sufficient but made it clear that it was only in this specific instance, and Discovery e-mailed the 2026 form to us.

At least we now had a copy of the elusive 2026 form!

We object to much of the form’s content, beginning with the fact that it appears to be a Discovery Health Limited form rather than a Discovery Health Medical Scheme form.

The definition of a third party is particularly problematic as they created the impression that Discovery may dictate who you are able to appoint to represent you and the parties that you may appoint are all related to Discovery!

"A third party is any person or entity that has a relationship with Discovery Limited; Discovery Health (Pty) Ltd; your Scheme, Society or Fund, administered by Discovery Health (Pty) Ltd."

At Claims Hound, we do not believe this sentence belongs on the form, as constitutionally there should be no restriction on whom you may reasonably appoint to represent you as a third party.

We specifically raised this issue with Discovery Health (Pty) Ltd, but the wording remains on the form, suggesting they consider it appropriate.

We believe the current form has several other problems and have raised these with Discovery Health (Pty) Ltd, the for-profit, administrator of Discovery Health Medical Scheme.

You can find the Discovery “PERMISSION TO MAKE CERTAIN INFORMATION AVAILABLE TO A THIRD PARTY 2026” form, along with forms for several other medical schemes, on our website:

https://www.claimshound.co.za/3-rd-party-consent-forms/

We would like you to look at the content of the PPROFMED consent form and compare that to the Discovery form. (We think that the Discovery form has many purposes over and above granting third party access to your chosen person.)

Please share your experiences with YOUR medical scheme in getting third parties authorised to represent you.

Please share your thoughts on the Discovery and other authorisation forms available on our website.

In conclusion, as a newly appointed third party, did you receive a marketing call from one of the Discovery companies shortly after being registered as such?

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