Why we are not a preferred provider

Why we choose not to be a ‘Preferred Provider’

At VC Dental we accept and treat patients from ALL health funds. For your convenience, you can claim your health fund contribution on-the-spot using our HICAPS system.

What is a preferred provider?

Firstly, it is important to note that the term “preferred provider” is not a reflection of the quality of the dental practice, their standard of clinical care, or the skills or ability of the dentist(s).

A preferred provider is a dental practitioner, or a dental practice, who has entered into a contract with a particular health insurance company. By entering into the contract, the dental practitioner, or practice, agrees to accept a fee schedule and any associated terms and conditions as determined by the respective health fund. This means the dentist, or dental practice, agrees to charge set fees for specific services to members of that health fund.

Dentists, or dental practices, can enter into multiple different contracts with multiple health insurance companies.

So, dentists, or dental practices, who choose to be preferred providers are actually contracted to the health fund.

The dentist, or dental practice, then become a “preferred provider” for that health fund. The health fund deems them a “preferred provider” because they have agreed to meet the fee criteria set by the health fund, and have agreed to be contractually bound by the health fund. The term “preferred provider” is not a reflection of the quality of the practice, or the skills or ability of the dental service provider(s).

In return for becoming a “preferred provider”, the health insurance company ‘recommends’ the “preferred provider” dentist/practice, and refers their members to that dentist/practice.

The health fund may also advertise/incentivise “no out-of-pocket expenses” or “reduced out-of-pocket expenses” to their members, but only if you see one of their “preferred provider” dentists.

Some private health insurance companies actually own the practices that are “preferred providers”, and employ the dental practitioners.

Free to choose your dentist

At VC Dental, we strongly believe that private health insurance companies should not influence their members’ rights to choose the dental practice, and dentist, providing their care.

Patients should be free to choose a dentist they feel comfortable seeing, rather than who the health fund ‘recommends’ them to see.

Further, patients should not be penalised for choosing to attend a dentist whom has elected to remain clinically and financially independent from a health insurance company.

We are an independent dental services provider

We have elected to remain a clinically and financially independent dental service provider.

Providing optimal patient care that is individually tailored to each patient’s needs is our top priority. At VC Dental you will receive uncompromised service and treatment.

The services we deliver to our patients have no constraints, and cannot be influenced by any third party.

There are multiple reasons why we have chosen not to become a “preferred provider”, these include:

  • We are dedicated to providing superior service and high-quality treatment to our patients, and we are not willing to compromise on the quality of our service or materials.
  • We are committed to providing personalised, thorough care. We get to know our patients, and their families, individually. Our appointments are not rushed, and we take the time to ensure our patients are feeling relaxed and comfortable before, during and after treatment, and they feel completely satisfied with their treatment direction.
  • We believe our services and treatment should only ever by influenced by our values and each patient’s individual needs, desires and situation. Not by a third party such as a health insurance company.

 

Is it fair?

Our belief that patients should be free to choose their own dentist with no influence from their health insurance company is supported by the Australian Dental Association (ADA).

Below is an extract from an article published on the ADA website (www.ada.org.au).

Another step toward the end of Preferred Provider Schemes (25 October 2018).

“Private health insurance is sold as allowing consumers choice; but in reality, the current system offers differential rebates based on who provides that service and restricts that choice. If you hold an extras policy with a health fund then you should get exactly the same rebate as anyone else who holds that policy regardless of where you live or which dentist provides the treatment. (Dr Hugo Sachs, President of the Australian Dental Association).

The ADA has always maintained that preferred provider schemes are not in the best interests of patients or dentists and have called on all health funds to dismantle their schemes and pay the same rebate for the same treatment under the same policies. This position was echoed in the findings of the Senate Inquiry into the value and affordability of private health insurance which recommended that Commonwealth legislation is amended to prohibit the current practice of differential rebates for the same treatments provided under the same product in the same jurisdiction.”

 

Conflict of Interest

Regarding the situation where private health insurance companies may own their own dental practices, the following article was published in Bite Magazine (www.bitemagazine.com.au).

The problem with preferred providers (February 10, 2015).

The following quotes are from Dr Terry Pitsikas AM, chair of the Australian Dental Association’s Schedule and Third Party Committee.

“ “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,” he (Dr Pitsikas) says, describing a clear conflict of interest that is not visible to the patient. 

A more extreme example, he says, is a bookie at a race course who also owns the race course itself and all of the horses, trainers and jockeys. “Then add in the fact that they charge people to come and watch and then are instructing the jockeys in how they must ride their horse during each race,” says Dr Pitsikas.”

Dr Pitsikas also said that “health funds actually owning dental surgeries”…“introduces serious ethical issues”.

 

‘The problem with preferred providers’

In the Bite Magazine (www.bitemagazine.com.au) article:

The problem with preferred providers (February 10, 2015).

Chris Sheedy spoke with “experts about the future”.

Julie Parker, co-founder of Julie Parker Dental Management stated that:

“ “I recently looked into what happens to your income as a business owner when you become a preferred provider, and also what you have to do with the structure of your business and what you need to do as a practitioner of dental services when you discount your fee,” says Parker,

“The benefits you receive in terms of more people coming through the door ends up creating a false sense of security. Suddenly, as a business, you’re functioning on a much lower dollar amount and compromises have to be made. They might include quality of staff, lower wages, quality of materials, and less funds for staff training and development. The result of becoming a preferred provider is a reduction in your ability to provide the sort of service that you would usually choose to provide…” (Julie Parker).

The Australian Dental Association (ADA) shares Parker’s worries.”

 

Further Information

For further information please download the following fact sheets from the Australian Dental Association (ADA):

 

We accept all major health funds, including: