In recent years some health funds have introduced preferred provider schemes. These schemes mean your health fund can dictate which dentist you can see. It does not decrease your premium or increase your annual limits.
YOU should be able to choose to see the Dentist who YOU PREFER, rather than the Dentist that the fund prefers you to see. The idea of having private health cover is to give the individual freedom of choice with the health professional you attend. You lose this freedom to choose the dentist you want with “Preferred providers”.
Whoever heard of a health fund carrying out a rigid selection procedure by considering dentists who met proscribed standards before making them preferred providers? Preferred Providers are NOT preferred because of their dental ability, but because they make a financial agreement with the health fund. These contractual relationships between an insurance company and a dentist of their choosing is generally beneficial to the Health Fund but not to you! Health funds are not concerned with the quality of treatment, they are only concerned with selling policies to patients and then minimizing payments back to patients for dental treatment thereby securing shareholder profits.
Which business would willingly give control of their business to outside organizations and bit by bit see the health fund restrict dental rebates that are paid out to patients, so they can divert this money to fund hospital policies, where it is more difficult to restrict rebates to doctors. The fundamental issue I have with this sort of scheme is that it inevitably leads to the basis of comparison being fee structures alone, rather than the quality of the treatment provided and the quality of the surrounds in which that treatment is provided. Such comparisons assume that all dentists are identical in their ability and their standards, this is just not the case. No two dentists, and no two dental practices are exactly alike in the mix of the treatment they provide and the efficiency with which they do it. Will you see the same person again, are they experienced, can you communicate with them? Will they take the time to do the job correctly since they get the same fee whether the filling takes 30 minutes or 1 hour to do?
Health funds (eg Medibank Private) discriminate by paying me $80 for a check-up and clean on a patient. My patient then telephoned their previous Dentist who was a preferred provider and the health fund would pay the preferred provider Dentist $168 for the same treatment. That is not a level playing field. The preferred provider Dentist gets twice what I would get for the same treatment. Health funds also direct my current patients away to preferred provider Clinics. These preferred provider Clinics are employing Dentists at a rate of $40-$50 per hour. Please read “IS EXTRA COVER WORTH IT” to see whether your extra’s cover is value for money. There are alternative health funds that provide value for money rather than the four (4) major health fund providers.
The Dentist you entrust to look after you and your family, should no longer do just fillings, scale and clean. I have undergone additional education and training to assess peoples breathing, are they predisposed to sleep apnea, are their children breathing through their nose, will they need braces in the future. I have been trained in injecting muscle relaxants, dermal fillers and skin care which allows me to give advice on these matters relating to the face which will allow the work I do inside the mouth be framed in the best possible way.
Once a Dentist enters into an exclusive arrangement with a health fund and becomes a Preferred Provider, the dental practice must restrict each service fee to a maximum amount dictated by the health fund. Health funds force you to charge what they want in return for sending patients to your practice.
As the funds reduce the money paid to a Dentist through rebates over time (as seen with Medicare rebates for doctors) and the Dentists overheads increase, the “Preferred Provider” may do the following:
- generally, reduce appointment times, work at an increased speed, do the bare minimum
- Not spend time on checks in the mouth that require time, such as oral cancer screen, sleep apnea, prevention of future orthodontic issues in kids, oral hygiene
- They employ auxiliaries (eg Hygienists) to do the scale and cleans as the cost of employing them is cheaper than the Dentist time. The Dentist see the patient briefly for a quick 5 minute look
- The Dentist doesn’t spend tim on examining the mouth to screen for conditions that require time, such as an oral cancer screen, sleep apnea, prevention of future orthodontic issues in children
- The Dentist is not interested in continuing their education as they won’t be able to charge for new knowledge gained
- 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
- Many send their patients laboratory work (i.e. Crowns, implants & dentures) to a laboratory who in turn sends it overseas (mainly Indonesia and China). This saves a significant amount of money but in a vast majority of cases the work is of poor quality and these savings are not passed onto the patient.
- There have been instances reported to the Australian Dental association of unethical treatment carried out by preferred providers who letter box drop offering free check-ups and then advising patients of unnecessary multiple fillings and multiple crowns. Its production line dentistry and the patient best care is put last.
The Australian Dental Association does not support these ‘preferred provider’ contracts and believes their intent is that the Funds will eventually be able to control the level of fees and services. If you value good service and honest advice, then you must have a direct relationship with your Dentist, and not one which has an insurance company influencing such an important relationship.
Choice magazine did a recent review (June 2016) of health insurance extras cover and concluded that they represented poor value and suggested health fund members should drop this cover.
For these reasons, I am not a preferred provider. Should you choose to make an appointment with me, I look forward providing you with a comprehensive service and honest advice. Thanks, Dr Basil.
For more information, please visit www.choice.com.au