I have been hearing a few grumbles of unhappiness with health funds lately. With this in mind, and the health fund reforms coming in soon, it’s a good time to talk about extras cover and why we are not preferred providers for any funds.
What is ‘extras’ cover?
Providers such as dentists, physiotherapists and optometrists can be covered as ‘extras’ under some health insurers (although we believe all health services are in fact essential, not ‘extra’!) . The amount covered varies between different health funds and within the level of cover for each fund. Most have yearly maximum limits. These limits and rebates are set by the fund. The dentist, physio or optometrist you are paying has no control over your rebates.
According to the ADA, “from March 2012 to March 2017, average dental fees per service only rose by 3%, with dental fees overall just keeping pace with the Consumer Price Index; by way of contrast, while the average rebate fees paid out rose 4%, it was dwarfed by a staggering increase in premiums of 38%”.
Our fees at Dentistry on George are based on the ADA’s averages. Our fees have stayed level at the average for some time now. If you are getting less back from your health fund than in previous years, it may be time to re-think your fund.
Why we are not a ‘preferred provider’
The term ‘preferred provider’ (or ‘member’s choice’) is in fact very misleading.
Preferred providers have entered into a financial agreement with a health fund:
- the health fund sets the fees which the preferred provider can charge
- in return the ‘preferred provider’ will receive more patients through the health fund.
These providers are not ‘preferred’ in that they are more qualified or better dentists, it is purely a financial agreement. Some of these preferred providers are in fact owned by the health fund, which many believe is a huge conflict of interest.
With their Time to Switch campaign, the ADA argued: “Insurers are also increasingly in a position to potentially influence how treatments are delivered. Their ownership and operation of dental and medical practices to which they might refer you with the promise of higher rebates can lead to a tiered system for customers, meaning that while you might pay the same premiums as everyone else, you may not receive the same rebates”
We believe your health comes first. We offer tailored treatment options that suit you, not what your health fund will give a rebate for.
If you feel it is time to review your health cover, or perhaps as one patient called it ‘self-fund’ – putting money away every month instead of paying it to a health fund and using it for dental expenses – here are two great websites to help you compare funds: