We’ve had questions recently about whether we’re a preferred provider for this fund or that fund.
Dr. Draper is a Dentist recognised by all health funds and claims for reimbursement can be made for treatments covered by the individual’s policy.
We have HICAPS facilities which allow for instant electronic claims processing for most dental services with participating funds (details here). For some participating funds, we are able to provide an estimate of rebate that may be paid, but increasingly, funds are preferring members to contact them directly for this service.
With his training and experience, the value Dr. Draper brings is based on providing the right diagnosis, and delivering the right treatment to the best standard in a hygienic, well equipped, caring and comfortable setting using the most effective techniques and supported by professional staff.
Who are you a preferred provider for?
- Currently, we’re a partner with HCF in their “More for Teeth” program.
- We are a recognised provider for the Department of Veterans Affairs.
- We are recognised for the Medicare Child Dental Scheme. We bulk bill for entitled children with no out of pocket costs depending on eligibility and program rules.
- We are on waiting lists to join other schemes (Bupa, Medibank Private, TUH), but do not know when or if we will be admitted. It could take years and our entry will depend on other providers exiting the networks.
Who are the Health Insurers?
Many health funds are commercial for-profit companies, while others may be mutual societies, and others are not-for profit. Each of these insurers set their own business rules about how much they charge in premiums, how and what they offer as “extras” cover, and importantly how much they reimburse members.
What is a Preferred Provider?
A preferred provider for each of the health funds has agreed to a commercial arrangement with the insurer in relation to pricing. There is no “standard” master price list that all health funds abide by. Each provider must enter into a separate agreement with a particular health insurer. Preferred providers don’t have special qualifications or higher standards. Rather, the insurer believes that the fund will not outlay as much in treatment costs, and the provider believes that it will bring more traffic to their business as a result of the agreement.
It is important to note that health insurance premium increases have been greater than inflation for a number of years. Dental prices have risen less than this. This has created an increasing gap to be carried by the patients and dentists while insurers continue to see great profit results.
What will my out of pocket cost be?
This is a difficult question to answer accurately. We can estimate. Each person’s unique insurance policy is the most important consideration. We are able to estimate for many funds (the funds listed here). If your health fund isn’t listed here, then the best our practice can do is provide you an itemised estimate of our invoice price, but you will need to speak with your fund about the rebate. We are advised that we cannot do this for you.
There is the possibility that at the time the transaction is processed, other entitlement considerations in relation to your policy may vary the amount paid. Our invoice price will be the amount charged to you and is not related to the rebate paid.
Do you offer “no gap” treatments?
For many funds, it is impossible to know what your rebate will be for a given fee. We also don’t know what your particular health fund considers the service to be worth. (I’ve asked, they will not provide this). This amount varies between funds. Some funds will pay a percentage of an amount they view to be fair, others pay up to a ceiling, and other approaches are also used. To give you an indication of the absurdity of the situation, Medicare Child Dental, DVA will pay much more (an amount much closer to the average fee found by the Australian Dental Association) than some funds will pay for the most basic services.
That’s why we talk about an “invoice” price in our discussions with you. That is what we have determined is a reasonable price for the service. You have our promise that our fees are set at a fair level and are continually reviewed.
I recommend caution with any provider offering a blanket “no-gaps” policy.
What to do?
If you’re not happy that we’re outside of your preferred provider scheme, please ask your health fund to get in touch with us and also let us know. We’re keen to consider any arrangement that allows people to get the care they need.
If you’ve not been happy with your service from another practice which is within a preferred provider network, then you need to make a complaint to your fund about it or they will remain and operators like myself won’t have an opportunity to enter.
We think you’ll find the service we provides really justifies the modest fees we charge and that you should have the right to choose your provider. If you agree too, then please consider changing your health insurer to one which is a better fit for your needs.