You should be able to visit the dental practice that YOU prefer
At DentArtisans, we provide quality dentistry. In healthcare the best treatment decisions are made through consultation and mutual understanding between patient and clinician, and without influence from the health fund. It is important to be comfortable and confident with your dental team who are recommending the best treatment for you and that they will provide continuity of care.
Generally 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 or to maximise rebates under their insurance policies.
We feel strongly about why you should see the dentist who you prefer, rather than who the fund tells you to see. Our practice will look after patients from ALL health funds. For your convenience, you can claim your health fund rebate at on-the-spot via our HICAPS system.
Conflict of interest
Our position is supported by the Australian Dental Association (ADA) who have officially endorsed that in the past 10 years 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,” . An obvious conflict of interest that is not visible to the patient.
Rebates & Preferred providers
“Preferred Providers” are NOT preferred because of their dental ability, superiority or reliability of care that they give but because they make a financial agreement with the health fund. The health fund's priority is 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. The health funds focus is to encourage patients to go to practices that they have financial arrangements with because it benefits them (and they profit from this).
It is very unfair for patients to pay premiums to private health funds but get lower rebates because you go to the dentist you prefer. You deserve the best care and the same rebates as other contributors regardless of which dental practice you visit. Unfortunately this is a not a reality in Australia.
Continuity and Quality
Once a dentist enters into a "Preferred Provider" arrangement with a health fund, the funds may reduce their rebate over time while the dentist’s overheads will inevitably increase. This may force some businesses to cut corners, work at an increased speed, bill additional item numbers, use cheaper quality materials and send laboratory work to cheaper overseas dental laboratories with poor quality control measures. The health fund interferes in the decision-making process about your care when decisions about your treatment are based on the best rebate payments offered by the health fund.
We make a point to take care to discuss the treatment options with you and to develop a treatment plan based on your oral health goals, your requirements and your expectations.
Time to review?
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 to review your fund.
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. 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.
For more information please read:
"It’s Your Choice" published by the Australian Dental Association.