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Treatment Rebates for dental patients on HBF,Medibank Private, HIF, HCF and GMHBA

For your convenience as a dental provider we have a HICAPS Dental Health Fund and Insurance Billing terminal and can process your dental health fund or insurance claim at the time of treatment.

All you have to do is present your card and our computer system interfaces with your health fund or insurance. You then only have to pay the "gap". It is easy and all figured out on the spot by the computer.  No more waiting in line at the health fund/insurance counter for your rebate.

If you are looking for a "Preferred Provider" you may be interested in the excerpt  information below the logos at the bottom of this page. Please read it in it's entirety on the copyright link provided and contact the ACCC or your insurer directly for more information.

There are different waiting periods for members dental services that apply for various ancillary benefits such as optical and dental on Medibank Private and HBF as well as most other plans. Often preventive treatment like check-ups, x-rays and cleaning have a short waiting period.  Crowns and bridges will usually have a longer waiting period. Some funds are now offering instant claiming - join now and they waive the two month waiting period.

Below we also list the logos of some of the other popular Dental Health Funds in Western Australia on the HICAPS.

HBF, Medibank Private, HCF, AHM, HBA, HIF,GMHBA and SGIO are some of the more common Private Health Funds in Western Australia Perth area but there are many others that assist with dental treatment rebates.

We now have many CHEVRON employees with United Concordia insurance and will gladly assist with filling out your claim forms with all the USA codes and teeth numbers.  (Dr Yudelman was a participating provider with United Concordia during his 16 years in San Diego)

Report to the Australian Senate on anti-competitive and other practices by health funds and providers in relation to private health insurance For the period 1 July 2008 to 30 June 2009

Australian Competition and Consumer Commission23 Marcus Clarke Street, Canberra, Australian Capital Territory 2601First published by the ACCC 2009 10 9 8 7 6 5 4 3 2 1 © Commonwealth of Australia 2009. This work is copyright. Apart from any use permitted under the Copyright Act 1968,
no part may be reproduced without prior written permission from the Australian
Competition and Consumer Commission. 

Please click here for link to full report on ACCC website in PDF format.

"The ADA was concerned that some health insurers could interfere with, or influence, their members’ choice of dental care provider in a number of ways:
Health insurers have advised members seek treatment from dental practitioners who are the insurer’s ‘preferred providers’, at times giving incorrect reasons why a particular practitioner is not a preferred provider. This can include creating a misleading perception that not being a preferred provider means practitioners have inadequate qualifications or provide substandard levels of care.  Some health insurers’ business rules relating to rebates payable can result in patients sometimes not opting for a course of treatment that is best suited to them, e.g. some insurers’ use of a ‘reasonable utilisation level’ which can constrain the way in which treatment is provided, as they can be based on economic parameters and not clinical evidence.
The ADA was also concerned that some insurers could take unilateral action against some dentists: derecognition, where patients would not be eligible for benefits for services provided by those dentists, and automatic recognised provider status.
In the ADA’s view derecognition of dentists could potentially damage patient perception of the affected dentists, while the granting of recognised provider status to dentists, despite no previous contractual relationship, may affect competition and patients’ choice of dental service provider.
The ADA also considers that the provision of higher rebates to patients treated by an insurer’s preferred  provider is discriminatory to some consumers: As all members of a fund will pay identical premiums, eligibility for rebates should also be identical. To increase a rebate available to one member who chooses to use a preferred provider discriminates financially against the member who chooses to maintain a dentist / patient relationship that may have existed for years. To place financial incentives to break down that trust is contraindicated to the provision of quality dental care. Such discriminatory conduct should be declared illegal as against the interest of the member.
The ACCC has been dealing directly with the ADA on a number of these issues."

Below are some excerpts from the Australian Dental Association Inc.Submission to the Australian Competition and Consumer Commission (ACCC) -Report to the Australian Senate on anti-competitive and other practices by health funds and providers in relation to private health insurance.

Please access the full report in PDF format here.

 The ADA sees health funds as interfering with the delivery of dental health care by the adoption of some of the following practices:
Seeking to influence patients in the selection of their dentist for treatment.
Quite often patients are advised by fund staff to seek treatment from practitioners who are preferred providers of a particular fund. Quite erroneous reasons are provided to the fund member by the fund. This practice is most unfair to those dentists who choose not to enter into a contractual relationship with a health fund.The inference of being a preferred provider promoted and advertised by health funds is that the dental providers not listed are “not preferred” or “not approved”. This has created a misleading perception in the public’s mind that these uncontracted dental providers have inadequate qualifications or provide substandard levels of care. This is both a deceptive and misleading activity by the health funds.

The above content is copyright by its owners and is not from dentistnedlands.com.au but reproduced here as a public information source on where to access more reliable  information from authorities ACCC and ADA on dental health fund rebates and preferred provider schemes.