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Health-fund dental coverage—use it or lose it

October 22, 2017
Posted By: Dr. Justin Ward
Family Playing on Beach | Dentist Coffs Harbour

The subject of health-fund dental cover is a tricky one. The rebate you receive will differ depending on your health fund and the treatment you receive. The way health funds cover dentistry is not necessarily about maximizing benefits for the customer. They’re a method of economising for the provision of services across the whole range of treatments—and customers. That’s why it’s important to choose a fund based on your own needs.

Use your dental coverage or lose it

I’ll start by saying if you don't use your health-fund dental cover, you stand to lose the rebate benefits. That’s the primary thing to remember when dealing with heath-fund preferred dental providers.  As a preferred provider with HCF, I can tell you that it’s in your interest to use it. Otherwise, you lose it. The whole concept of a preferred provider for any health fund is a little bit misleading, in that it suggests that a dentist chosen by that health fund is somehow better skilled or qualified than others. In fact, the choice is based purely on a contract that the fund has signed with that dentist, and which charges a set amount for the service.

What it means to be a preferred provider

By that standard, the integrity and quality of your dental service is dependent upon the particular health fund you’re using. The issue I have with this system is that people lose their autonomy in choosing the dentist they want to see. The health fund dictates who they can see, which negates that trust relationship with an individual practitioner that people prefer in matters of health.  

It's the same as when you go to a doctor. You build a relationship with an individual, a dependable practitioner that you respect. The quality of that relationship is not based on the fees. Health care is an intimate process and that trust-based relationship is integral to a satisfactory experience. When that relationship is compromised by a health-fund provider based on the contract they’ve signed with a dentist, it can in turn force the dentist into compromising the treatment. If the work that dentist is going to do will only provide them with half the dollar value of what they would normally charge, then from a business point of view, they're going to have to make it up somehow.

How we manage it

That gets frustrating for the dentist. You can't necessarily offer optimal care for every patient if one of the patients health fund is providing substantially less income. That’s why I like HCF. Theirs is a preventative-based service that only controls hygiene maintenance. They have an excellent active maintenance service which is beneficial for patients. And with the HICAPs system as it stands, you can swipe your health-fund card and receive an on-the-spot payment. That’s a far cry from the old system where you had to line up and wait for your payment to be sent out. HICAPs does what it sets out to do—provide a simple and easy health-claims-and-payments solution for health-care providers. And that ease of payment is one of the biggest advantages of being in a health fund.




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