If you have what is popularly known as “extras” cover – your fund officially calls it either general or ancillary treatment cover – which includes things like dentistry, optometry and physiotherapy, you could be forgiven for thinking there is no rhyme or reason behind the rebate amount you receive when you make a claim.

After all, your fund isn’t exactly rushing to tell you how they calculate the amount and they are more apt than not to lay the blame at the foot of your dentist (or other healthcare providers) than their own policies.

Your dentist is not to blame
There are a number of factors that shape your rebate amount, and contrary to what your fund may tell you, your dentist is not the issue.

For example, 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%.

You are, in other words, considerably worse off and it’s not the doing of your dentist, who has effectively capped their fee increases well below those of premium increases by your fund.

One of these policy holders is not like the other
Quite a number of insurers are trying to direct policy holders like you to their own contracted dentists (they may use the warm-and-fuzzy term “preferred providers”, which is misleading since they are no more or less qualified than your own highly-skilled dentist) or their own clinics with the promise of higher rebates.

Sounds like an easy decision, right? They’re offering you more money if you use their dentist. The sting in the tail though is that it means leaving your dentist behind, someone who knows your treatment history and the best way to treat you. If you choose to stay with your own dentist, then you are effectively being discriminated against by your own fund.

Mind the gap
So the next time you’re staring into the yawning chasm between the fee you’ve paid to your dentist, and the rebate your fund has handed back to you, remember that your dentist is in your corner. If your insurer ever tells you that you are getting back such-and-such an amount solely because of the fees charged by your dentist, remember that the amount you receive back as a rebate is entirely at the discretion of your fund.

Would you like to take some concrete action? You can file a complaint with the Private Health Industry Ombudsman and also add your voice to our Time2Switch campaign, where we are working to restore balance to the relationship between patients like yourself, the dental profession and private health insurers.

Feel free to call or email us if you have any questions in regards to your health insurance. We may not know all the answers but we will try our best to see if you can help you!

Source:Choosing an Insurer – Australian Dental Association