Discovery’s ******** Handling of PMB Claims and Failure to Respond

I am extremely disappointed in Discovery’s handling of my Prescribed Minimum Benefit (PMB) claims. On 18 August 2025, I sent a detailed email regarding several claims (including those for L van Zyl and Dr Meintjes) that were incorrectly rejected with reason code 274 (MSA depleted), despite being valid PMB conditions. On 19 August 2025, I followed up with another email regarding a further PMB claim for Steenkamp and Pollock.

To date, I have not received any response to either of these emails. In the meantime, I am receiving threatening correspondence from doctors’ practices who are preparing to hand my accounts over for collection due to non-payment. This is entirely unacceptable, as PMB claims are legally required to be covered in full from risk in terms of the Medical Schemes Act and Council for Medical Schemes (CMS) guidelines.

What makes this worse is that Discovery continues to insist that members must complete application forms and obtain prior authorisation before PMB claims will be paid. This is completely ******** and directly contradicts CMS directives, which state clearly that schemes cannot require forms or pre-approval for PMB conditions. By continuing this practice, Discovery is effectively acting as though it is above the law and disregarding the regulatory framework put in place to protect members.

Not only is Discovery ********ly rejecting PMB claims, but it is also failing to respond to formal written complaints and leaving members at risk of being blacklisted by healthcare providers. This reflects a serious failure of service, governance, and compliance.

I expect immediate action to reprocess all affected PMB claims, reimbur*****t where I have already settled accounts myself, and written confirmation that these claims will be corrected in line with CMS regulations. Until such time, I cannot recommend Discovery to anyone who expects their medical scheme to follow the law and provide reliable service.