What is an Independent Dentist? An independent dentist is a practitioner that has no affiliation (that is, no “preferred provider” status) with a health fund or a corporate entity.
What is wrong with a Preferred Provider Scheme (PPS)? On the Outside they look great. You get little or at least a known out of pocket expenses when you have treatment at a PPS dentist. However the reality can be quite different.
So where does the PPS model go wrong? The main feature of a PPS is that a dentist signs an agreement with a health fund (HF) to treat the patients of that HF for a set fee. This fee is set by the HF, who has no knowledge of the actual expenses that go towards provision of that service. And so they are almost always below the fees which would usually be charged by the dentist. A negotiated lower fee by the HF may seem like a great idea, but a dental practice is also a business, and has to remain profitable or it will go out of business. So a PPS dentist must then decide how best to “pay” for this reduced fee – and this is where it goes wrong. Offsetting the fee reduction can be achieved in a number of ways:
- By decreasing the time taken to provide the treatment. Potentially this could mean it is done at a lower standard, or even rushed. I still hear stories of dentists not allowing enough time for the anesthetic to work so the procedure was painful. We also hear of instances where a dentist was too rushed to properly explain procedures and alternatives. We pride ourselves on taking whatever time is needed to discuss treatment and alternative treatment plans. We also allow for the possibility of a slow onset of anesthesia. Shaving a few minutes off the appointment means cutting a few corners, which could shorten the life of a filling by half. This means that cheap filling will eventually cost at least double.
- By using cheaper and possibly inferior materials that could lead to early failure. At our practice the materials used are handpicked for their proven track record, not what is on special at the time. Again, decreasing the life of a restoration will ultimately cost more.
- By engaging Overseas Laboratories that use crown materials that are not TGA approved in Australia. Our labs are all based in Perth, so all materials are known and if needed I can even visit the lab to ensure I get the results that I need.
- In the reduction of staff numbers. This has the potential to impact upon the level of infection control that is practiced. We exceed the minimum infection control guidelines in the Australian Standard. Every instrument is tracked to ensure sterility at all times.
- By deciding not to offer treatments that are poorly remunerated by the HF. As the fee is determined by the HF, they can influence what treatments are carried out. I recently heard from a colleague that the PPS they participate in have decreased the rebate on a number of treatments for 2016 – by as much as 30%. One of these was large tooth coloured fillings. So the dentist made a business decision to only offer mercury amalgams in larger fillings to patients who belonged to that particular HF. Other patients with other HFs had a choice in what material was used. This is wrong. We will recommend what is best for your dental health only, not what pays the best rebate.
- Playing the numbers game. Many bills I have seen by PPS dentists over the years have been manipulated to get the maximum fee and overcome the shortcomings of the reduced fee the HF sets. This is not done fraudulently, but often a filling will only slightly go onto an extra surface to be upgraded to the next size. If we quote someone for a filling and it ends up slightly larger than we quoted we will always honour the quoted price. Also there are many items I do not simply charge for, because they form part of the service. For example I charge for a maximum of three x-rays on any give appointment when for a new patient I may take eight X-rays or even more if needed. Most PPS dentists would always charge the full amount (to try to make up for the reduced fee). I have seen many instances where the patient has switched dentists on suggestion of the HF even though they were happy with our service but were promised less out of pocket expenses. Due to the manipulation of fees and codes as described, they ended back here, disgruntled and out of pocket by more than if I had done the treatment.
An Independent Dentist (ID) first and foremost has your best dental health as their primary goal. We treat everybody to their needs, not to which HF they belong to. HF have no business dictating what treatments can and can’t be done. As you have private insurance shouldn’t you be able to choose for yourself the practitioner that you feel comfortable with, without being penalised financially by the HF? As an ID I firmly believe this is wrong. If you want to regain the power of choice, maybe it is time to switch funds – not the Dentist you know and trust, and who knows you.
There is a fund that has pledged to not take away your choice. HIF has been working with the profession to tailor packages that recognise your good standing with your current HF and will waive all qualifying periods you have served with your old HF. It is easy to switch and their rebates are very good. Best of all you can see any practitioner you choose with the knowledge you are getting the full benefit of the Health Insurance you have paid for. Dr Ziepe has recently swapped from HBF to HIF. It was a 10 minute phone call (or simple online process) and HIF did everything else.