GEMS healthcare management executive Dr Stanley Moloabi said the scheme was funding treatment without "hesitation" for Muhammad Hussain.
"Effectively the life-saving medication which was duly authorised by GEMS did not match the claim that was eventually submitted by the healthcare service provider."
He said treatment continued throughout. "Given the serious nature of Muhammad's illness, the scheme is consulting with the healthcare provider so that he can correct this administrative mismatch to ensure treatment will at no stage be interrupted."
He said the family had been informed about the decision.
FEDHEALTH's principal officer, Peter Jordan, said the scheme had already paid R265000 for six months' worth of specialised medication for Edith Backlund.
"The specific type of medicine she requires comes from the specialist drug benefit which has now been depleted. The scheme is reviewing her application."
He said chemotherapy was "per se unlimited".
"But the specific treatment [Backlund] requires is a biologic specialist therapy which is not unlimited."
Regarding Estienne Smith, Jordan said "bariatric surgery is a scheme exclusion".
When asked if they should change the policy for life and death situations, he said Fedhealth was guided by legislation which dictated that all schemes must provide cover for the prescribed minimum benefits.
"Over and above this, schemes need to carefully consider what they provide cover for. In order to remain sustainable, providing the broadest possible cover is balanced against membership affordability," he said.
Of both Smith and Backlund, he said: "It is critical to always put the health of the member first when evaluating a new treatment or a suggested course of action." He said the scheme often deferred to a panel of medical specialists to evaluate treatments in highly complex cases.
DISCOVERY Health chief executive officer Dr Jonathan Broomberg said the vast majority of treatment plans received from the members' treating doctors were approved immediately and more than 99% of claims were funded in full.
"There are a small number of complex cases which we refer to external panels and in these instances there are sometimes complex information requirements and these do occasionally lead to delays when the information is not forthcoming."
He said given the limited information provided to Discovery, it was difficult to make a full assessment. The woman who approached the newspaper asked to remain anonymous.
"But I am certain that the patient's case went through this rigorous process, which admittedly does take longer than usual.
"We are here to serve our members, and we try very hard to meet all their needs every day. By having her details, we can help ensure there is no unnecessary delay in approving funding for further treatments."