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Ben Wilcox
Ben is the practice principal at Shore Dental, Sydney. He graduated with a Bachelor of Dental Surgery in 2004 and…

Why We Are Not a Preferred Provider

January 13, 2017 by Ben Wilcox

Some people assume that the preferred providers of health insurance funds are so named because they offer a superior service or they are better in some other way. This is simply not true and – in fact – it can mean the exact opposite.  Dentists who choose to be preferred providers are actually contracted to the health fund.

What Is a Preferred Provider?

A preferred provider is a dental (or medical) practitioner who has met the fee criteria that is set by the health fund and agrees to abide by the fund’s contractual conditions. That’s it – it does not indicate whether or not they are a quality service provider or anything else.

Why do Some Dentists do this?

For one thing, they do it because of the assumption that patients will believe that they are better dentists by being a preferred provider. Also, being a preferred provider attempts to drive business to their practice because a health fund holder is more likely to attend a preferred dentist than one that isn’t listed with their fund. The free advertising on the health fund’s site also contributes.

Who does it benefit?

A preferred provider benefits the health fund primarily, because a preferred provider dentist is contractually bound to offer lower fees to the health fund. This means the health fund doesn’t have to pay as much for the same services. The dentist also benefits because they are able to draw in more customers. Unfortunately, a few dishonest dentists also benefit by performing unnecessary procedures, in order to recoup costs that they lose by being a preferred provider!

The patient benefits the least (or perhaps, loses the most), because even though they are covered under their fund and don’t need to pay as much then and there – they often pay hundreds (if not thousands) more to their fund than if they simply saved their money and paid the dentist outright. Also, because preferred provider dentists are so overbooked with health fund customers and these customers bring in less income, these dentists sometimes don’t spend as much time or care on their health covered patients.

Why Shore Dental will not do this?

There are multiple reasons we don’t want to become a preferred provider. These include:

The fact that we pride ourselves on our superior service and care for our customers. We also have our own in-house laboratory so that we don’t need to send work to cheap labs in foreign countries (China, for example). Because of this, we are not willing to compromise on quality in order to meet the needs of health funds.

Our commitment to you – our patients – isn’t compatible with the ‘conveyor belt’ like treatment many health fund members receive when they see a preferred provider. For example, many of our patients comment on the fact that they love coming to us for our hygiene appointments because they last for an hour and are extremely thorough. Unlike the 15-minute treatments that they receive from preferred providers that don’t feel are thorough enough.

We want to ensure you feel welcomed, relaxed and comfortable when you visit. We don’t want to simply get you in and out the door – we want to answer your questions, ensure you’re 100% satisfied with your treatment plan and the outcome. All of these things would be difficult if we were a preferred provider, as we wouldn’t have the time or be able to justify the cost.

We believe that our service and treatment should only ever be influenced by our values and our patients – NOT by a third party, like a health fund.

Why this is a good thing?

Because we do not think you should be restricted to below par dental care just because your health fund tells you to use their preferred provider. Instead, we believe you should be able to see your favourite dentist, who can provide the quality care that you deserve and return you the same rebates as other policyholders. Thankfully, we can offer you exactly that!

For further information regarding health funds and whether your fund is the best value for your needs, please see the Australian Dental Association’s new service where you can compare.

If you are feeling dissatisfied with your fund there is also the option to have your voice heard by the Health Ombudsman, with one simple click on the Time2Switch, ADA website.