Some health funds are engaging in aggressive marketing and telling their patients that they have to attend “Preferred Provider” or "Members Choice" practices in order to receive dental treatment and to maximise rebates under their insurance policies. Dr Martyn Sweet, Practice Principal at Kingston Beach Dental feels strongly about why we are NOT A “PREFERRED PROVIDER” PRACTICE. Kingston Beach Dental sees patients from ALL health funds. For your convenience, you can claim your health fund rebate at on-the-spot using our convenient HICAPS system.
We thought it timely to address some of the issues and explain how “Preferred Provider” arrangements work, why we are NOT a “Preferred Provider” Practice and why YOU should be able to choose to see the dentist who YOU PREFER, rather than the dentist that the fund prefers you see.
At Kingston Beach Dental, we provide quality and caring dentistry. The best treatment decisions are made through consultation between patient and dentist, and without influence from the health fund.
Our position is supported by the Australian Dental Association (ADA). Dr Terry Pitsikas AM, chair of the ADA’s Schedule and Third Party Committee, says that in the past 10 years that private health insurers have begun aggressively targeting an increase in the numbers of contracted dentists and that health funds actually owning dental surgeries raises serious ethical issues: “One of the problems we have philosophically is whether a health insurer should actually be providing the service for which they are charging a fee, providing a rebate and then charging the contributor a fee to actually join the insurer,” he says, describing a clear conflict of interest that is not visible to the patient. (Bite Magazine The Problem with Preferred Providers, February 2015).
“Preferred Providers” are NOT preferred because of their dental ability, but because they make a financial agreement with the health fund. Health funds are not concerned with the quality of treatment, only concerned with securing shareholder profits through an increased number of patients. There is no assurance about the quality of the work provided in a “Preferred Provider” contract. Health funds impose annual limits on the amount you can claim. If you receive higher rebates back at a "Preferred Provider" practice, you will reach the limit of what you can claim sooner and then be out-of-pocket. Unfortunately, the health funds focus is to encourage you to go to practices that they have financial arrangements with because it benefits them to do so, particularly once your limit is used up.
It is important to be comfortable with your dentist. We believe you should see the dentist YOU PREFER to see. You should feel confident being treated by them and knowing that they are recommending the best treatment for you. You also want assurance that you will have continuity of care with your dentist, and not have your right to choose dictated by your health fund and their contractual arrangements with particular dentists.
If is very unfair if you pay the same premiums as “Joe Bloggs” but get lower rebates because you go to the dentist you prefer. If you pay the same premium, you deserve the best care and the same rebates as other contributors, regardless of where you go.
Once a dentist enters into an exclusive arrangement with a health fund, the funds may reduce their rebate over time, while the dentist’s overheads will probably increase. This means the “Preferred Provider” dentists may work at an increased speed and use cheaper quality materials to maintain their income. Some dentists unfortunately may start to cut corners or make decisions about treatment based on the best rebate payments offered by the health fund, rather than what is the best option for you. There are examples of over-servicing and sending lab work to cheap overseas dental laboratories when decisions are made based on health fund rebates. The health fund has therefore interfered in the decision-making process about your care. The NHS in the UK is an excellent example of the poor level of dental care provided when a third party is the major influence on dental treatment decisions.
Insurance is usually to cover BIG problems and should pay to cover almost all of your expenses. Extras cover only covers a proportion of relatively small health costs. It may be more cost effective to save your Extras Premiums and use the money you have saved directly towards health costs. Remember that your health funds impose annual limits on how much you can claim. If you go to a preferred provider practice because they are offering higher rebates, you will reach the limit of what your health fund will cover sooner. If you are spending more on your Extras Premiums than your receive in rebates it might be time to review your policy and decide whether it gives you value for money. If you are unhappy with your current health fund, perhaps it is time for a review?
Questions to ask your Health Fund:
Why are you telling me I can’t I see the dentist I prefer if I am paying the same premiums as someone who goes to a “Preferred Provider”?
Why haven’t my rebates increased in line with premium increases?
Why doesn’t the fund charge me lower premiums if I am getting lower rebates back for seeing the dentist I choose to see?
Other Questions to Consider:
Why do dentists make financial arrangements to be “Preferred Providers” with health funds?
Was it because they had trouble filling their appointment book? If so, why?
Are you really getting value for money from your extras cover?
What can you do as a patient to ensure the best care available?
Choose a dentist based on personal recommendations and word-of-mouth. This is our biggest source of referrals at Kingston Beach Dental. We do not need to rely on arrangements with health funds to secure our patients.
Discuss your treatment and the cost with your dentist. They want to look after you and develop a personalised treatment plan, tailored to your needs.
Review your health insurance policy and ask your health fund the above questions.
ADA Cautions Senate about Health Insurers
The Problem with Preferred Providers
To review your health insurance policy