Melomed fight medical aid court battle to exclude Cape Flats hospitals

The Melomed Hospital Group is fighting a court case that could exclude medical aid from hospitals in Gatesville and Mitchells Plain.

They launched an urgent application in the high court accusing the South African Municipal Workers Union National Medical Scheme (SAMWUMED) of ignoring a previous court order.

The National Hospital Network (NHN) filed the application on Monday, seeking an urgent hearing in the South Gauteng High Court in Johannesburg.

This follows a December ruling that temporarily prevented SAMWUMED from removing Melomed hospitals from its list of approved healthcare providers.

In its application, the NHN alleges that SAMWUMED is in contempt of court for failing to comply with the order, which was issued amid a protracted dispute between private hospital groups and medical schemes over reimbursement practices. 

NHN said that it's seeking an urgent hearing date because it believes immediate judicial intervention is necessary to prevent ongoing harm.

The case forms part of a broader battle that has been simmering for months between hospital groups and large scheme administrators over how hospitals are reimbursed for services and whether schemes are lawfully entitled to impose or enforce certain billing rules

The respondents in the matter include Medscheme Holdings, one of the country’s largest medical scheme administrators, as well as two major schemes – Samwumed and Fedhealth – whose combined membership runs into hundreds of thousands of beneficiaries.

Earlier, SAMWUMED said its agreement with the NHN, which came into effect in January 2021, had expired and that Melomed Gatesville and Mitchell’s Plain hospitals would be excluded.

The NHN criticised this move and warned that removing Melomed facilities would have immediate and serious consequences for patient care.

In her ruling, Judge Nelisa Phiwokazi Mali underscored this sentiment, noting that once a facility is excluded from the network, repercussions are swift and cannot be easily reversed.

"Specialists move lists, patient flows are redirected, community expectations adjust, and reputation signals harden against the excluded facility...A later setting aside order cannot restore lost alignment, reconstitute referral habits, or reverse reputational attrition," said the judge.

Judge Mali further noted that excluding Melomed from the network would place a financial burden on patients, especially those who rely on public transport. She also warned that medical practitioners would be affected by reduced patient numbers and would be reluctant to open practices at the affected hospitals.

The urgent application is scheduled to be heard on 27 January 2026.