'Those who do not learn from history are doomed to repeat it." So goes the saying attributed to philosopher George Santayana. I was reminded of the philosopher's statement when I read about the medical aid giant, Discovery, sticking to its guns that there was no basis on which to review its decision to decline funding for the high-cost medicine needed to save an 81-year-old Hermanus resident despite medical schemes being apparently required to cover prescribed minimum benefits (PMBs), which include cancer, according to the regulations of the Medical Schemes Act.
Asking people to learn from events of the past can be a tough ask. However, one can reasonably expect them to remember them. Especially when they are in their face, in newspapers, on their TV screens, on their Twitter timelines and everywhere else they look. The age of consumers deciding whether brands do right or do wrong by them is upon us. It will serve many a marketing director and CEO out there to accept that this is the world in which they now live.
I have no doubt Discovery has considered this matter in great detail and did not make this call lightly. However, it may be wise for the medical aid's marketing team to consider a few things as they seek to manage the situation.
First, it may be wise to open yourself up to having an authentic conversation with the claimant. Even if you are right, you can be wrong purely because of the way you handle the human element of the matter.
Another insurer was faced with a similar situation and decided to issue a statement doubling down on its nondisclosure regulations and claiming to have support from the industry ombudsman. This move saw it come under heavy public scrutiny, with many disapproving of the technicalities it was seen to be using to avoid honouring a claim from a widow who had lost her husband in a violent crime. Although the insurer was well within its legal boundaries to take this route, this approach only emphasised the public perception that the corporate giant will almost always crush the small consumer guy.
Second, Discovery may want to take the opportunity to review the actual plan taken by the 81-year-old customer and perform a "substance over form" exercise on it. In other words, bar the legal form of the actual policy takeout - would a reasonable customer of the plan expect to receive this treatment?
According to reports, the client was diagnosed with a specific kind of cancer called metastatic melanoma. Discovery says that while the man's plan covered cancer, they denied the Keytruda treatment he needed as "it is a very high-cost medicine that is covered only on the DHMS Comprehensive and Executive plans" - which are not the plans the customer was under.
According to reports, Discovery CEO Jonathan Broomberg clarified that "PMBs referred both to a defined list of conditions and to certain minimum treatments for each condition" and added that "while cancer was a PMB, the medication requested does not form part of the PMB treatments". Again, a good technical reason for not honouring the claim, but is it enough to satisfy the customer's expectation?
The third and final point that Discovery may want to think hard about is the power of the media, especially social media. Within a day of such a story breaking in the newspapers, outlets such as radio and social media can quickly buzz with the matter. There is likely to be overwhelming support for the "victim" and his family, with many influential individuals applying pressure on the company. Why? 'Cos that's just how the Twitter streets work. Showing up with more humanity is the closest thing to a silver bullet. Either that, or just "remember the past" and don't repeat it.
• Khumalo is an entrepreneur and a CA (SA)..