Health Insurance & Preferred Providers
We encourage our patients to have private health insurance - if the situation is appropriate for them. The ADA has some essential questions you should ask yourself when choosing a private health insurer. Some of our patients ‘self-insure’ by allocating money for dental treatment, and seeing us regularly for preventive maintenance. Health insurance companies don’t have the same level of interest in your health that you and your dentist have.
Health Fund Rebates
In recent years, health fund rebates have failed to keep pace with the rising cost of living and some services claimable in a calendar year have become more restricted. To regulate cost blow-outs health funds try to actively engage health care providers on a contractual basis to maintain the profitable side of health insurance – ancillary cover.
Some health funds have introduced preferred or contracted provider schemes that claim to decrease your out-of pocket expenses. These schemes mean your health fund can dictate which dentist you see – it does not decrease your premium, or increase your annual limits. Similar treatment with a preferred provider will give you higher rebates and a lower gap payment, the net annual rebate remains the same for both preferred and non-preferred providers. You may get lower gap payments with a preferred provider, but you will be entitled to fewer claimable services in the same calendar year compared to a non-preferred provider.
To become a preferred provider the dentist signs a contract with the health fund agreeing to charge patients a pre-determined fee for any treatment carried out. It is not the health fund that chooses the dentist. Whilst the health funds often present this scheme as being based on quality of care, most health funds offer preferred provider status to any dentist who will agree to the terms of their contract. In return, the dentist hopes to receive more patients as they receive marketing from the health fund under a Health Fund Preferred Provider title. The “preferred” comes from the fact that the dentist is contracted to the health fund, and that is where their loyalty contractually lies – not with the patient. There is no requirement from the health fund for the dentist to deliver a certain standard of care or quality of treatment.
The fees set by the health funds are low so it doesn’t cost them as much. Health funds are not part of a government organization like Medicare – they are private companies and they have a simple agenda: to increase their revenue. The ideal insurance customer is one who pays their premiums regularly and claims as little as possible. Insurance for dentistry doesn’t work well for the insurer if there are regular claims – the insurance company does not make money if it routinely pays out more than it receives. Some people receive letters or have insurance company employees telling them to go to another practitioner – this generally happens if the insurance companies want the claims to be reduced. This is in no way beneficial for your health.
In order for any business to remain viable and to charge the fees dictated by the health funds, it means that corners need to be cut. Corners that can be cut are: time spent per procedure or patient, limited patient choices and services, cheaper/inferior materials, a drop in quality/service, use of cheaper overseas laboratories and cutting cost with infection control protocols. In summary, standards drop whilst treatment failure and patient dissatisfaction increases. Health funds are businesses and preferred provider schemes are business decisions.
Our Philosophy
At Elegant Smiles, we strongly believe that preferred provider schemes are not in the best interest of our patients. We agree with the Australian Dental Association statement “Health Funds set their rebates at a level that suits their commercial needs. Those rebates are not related to any recognised fee scale”. We believe it should be your choice to see which ever dentist you please. We believe that only you and your dentist has the right to decide what treatment is best for you – no two patients’ dental needs are ever the same and compromises in care may occur under arrangements where fees are predetermined for each and every patient. We pride ourselves on providing the best possible care and service to our patients and we do not, and will never cut corners on our materials or laboratories, infection control protocols or services.
Elegant Smiles remains committed non-preferred providers. We will not enter into a contract that compromises our independence in making decisions regarding the quality of your dental care. This decision has been made out of concern for the long term well being and freedom of choice for our patients.