Health Funds & Preferred Providers: An Explanation

Preferred Health Fund Providers FAQs

At Tewantin Dental Centre we often have patients asking if we are a preferred provider for their health fund. After starting a conversation, many don’t understand all of the ins-and-outs of how Health Funds and Preferred Providers work.

For this reason, we’ve answered some of the more common questions below along with the information provided by the Australian Dental Association.

What is a Health Fund Preferred Provider?

A preferred provider or preferred practitioner is a dental clinic that is contractually bound to a Health Fund’s conditions to deliver services at a specific rate. This rate is then matched by their rebate allowing the health fund to advertise that they have ‘no out of pocket expenses’ or ‘reduced out of pocket expenses’ so long as you see one of their preferred partners.

A health fund will often specify a list of providers that they ‘prefer’ you to go to. It is only these providers who adhere to the health fund’s marketing promises however in many cases you aren’t limited to only attending these practices.

What Happens If My Dentist Isn’t a Preferred Provider?

If your dentist isn’t a preferred provider you can still attend them for treatment however the full fee they charge will not be covered by your health fund rebate. This means that you will have some out of pocket expenses.

Why Don’t All Dentists Become Preferred Providers So Patients Don’t Have To Pay Extra?

In life, we accept and understand that the value of items fluctuates from time to time. We also understand that not all providers of any product or service deliver the same quality and from a young age we are taught that quality is often represented quite well in the cost of items.

If all dentists become preferred providers this measure is removed, and when you combine this with a contract that stops prices from rising in line with the practice expenses, you risk a practice compromising on quality to meet the cost specified by the health fund.

My fund offers me a higher rebate if I use one of their preferred providers. Is this a representation of quality?
Unfortunately, no. Some health funds now offer a higher rebate if you use one of their preferred partners. This is often a tactic Health Funds use to prove to their preferred partners that their alliance brings additional business. The only measure used by Health Funds to determine if a practice can be a preferred partner is cost.

Is Tewantin Dental Centre a Preferred Partner for Any Health Funds?

No. Due to all of the reasons listed above and unwillingness to compromise on quality, Tewantin Dental Centre has decided not to become a preferred partner to any Health Fund. This does mean you may have out of pocket expenses when visiting us as your health fund’s rebate may not cover the full fee however this allows us to ensure that our main focus is on providing you with the best possible treatment and service rather than simply meeting costs.

This said we do process HICAPS transactions in our practice to ensure your health fund claim is processed as quickly and easily as possible.

How Does HICAPS Differ to Being a Health Fund Preferred Partner?

HICAPS is simply the technology we use to process your standard health fund claim. The rate you pay is then the gap between the standard rebate amount outlined by your private health fund and our fee. This process then includes you swiping your healthcare card through the HICAPS machine, it gets processed electronically and then you pay the ‘gap’ via EFTPOS or one of our other payment methods.

For further information, please call our Noosa dental practice. If you have further questions about health funds and how Tewantin Dental Centre works with you please call us on (07) 5447 1361 or talk to us when you are in for your next appointment.