ACCC Private Health Insurance Forum looks at ‘Junk Policies’

We think the 20 Billion dollar Private Health insurance industry is well and truly overdue for a check up.

At the ACCC Private Health Insurance Forum held in June 2016, The ACCC notes;

It is difficult for consumers to understand complex Private Health Insurance Policies, otherwise known as ‘junk policies’ and Health insurance companies are increasingly engaging in anticompetitive behaviour.

Health insurance companies often fail to communicate policy condition changes and how such changes could adversely impact upon the customer.

Did you know that even if you were to take the time to research your policies each year, your policy could be changed midstream making all the research work you’ve done a complete waste of time.

You may not be aware that regardless whether you pay weekly, monthly or annually the health insurance company reserves the right the change the terms and conditions at any time.

Medibank is currently be investigated by the ACCC for failing to inform customers of critical changes their health insurance policies.

You may not be aware of discriminatory rebate practices used by health insurers who have contracted ‘Preferred’ Provider arrangements. This practice means that even though two policy holders may pay the same premium for the same policy – their health insurance rebate amount will depend of whether or not they see a contracted provider.

Medibanks’ recent promotion offering 100% rebate on ‘Check ups’ if you attend their ‘Preferred Provider’ Contracted dentists should be seen as a desperate rear guard action – from a Health Insurer who has finally had to admit they are losing customers. The ACCC notes that consumers are not afforded transparency when it comes to how contracted provider arrangements affect them. These issues not only affect dental care but also Optometry, Physiotherapy and Podiatry.

On the issue of privacy and your health data, Health Insurers are using data from independent health professionals without the practitioners consent so that they can direct customers to their own health funds clinics. Authorities as diverse as Graeme Samuel ex ACCC Chief, the CEO of the Private Health Advisory Commission and Choice spokesman Tom Godfrey have all criticised health insurance with Choice and PHIAC saying ‘extras cover doesn’t make any sense’’.

“Patients are better off paying for extras services themselves and banking the premiums”

From the perspective of long-term health of the dental profession, it would be better if nobody had extras health insurance and instead a simple one to one relationship with their dentist.

You may not be aware that ‘The Big Four’ Health Insurance companies – BUPA, HCF, Medibank and NIB are skimming 22 cents off in the dollar from premiums and have a stake in 73% of the market. Both dentists and patients are well and truly being screwed over with the 22% break off being partially contributed by the dentist in the form of control over fees and much of it wasted on advertising, administration and diversion to either the Insurance companies reserves or to share holders and parent companies.

Choice, March 2016 – “ Unless you are confident of receiving more in benefits than you’re paying in premiums, you should consider dropping your extra’s insurance. Our analysis of extras cover shows low average payout rates and savings of up to 45% available to consumers who drop it”

Important things to remember when you are insured by a ‘For-profit’ insurer

  • These funds are not part of a government organisation like Medicare. They are private companies and they have a simple agenda: to make profit.
  • Their ideal customer is one who pays their premiums regularly and claims as little as possible.
  • Insurance is great for avoiding catastrophes such as life insurance and fire insurance. But insurance for dentistry doesn’t work well for the insurer if there are regular claims. There is no way the insurance company can routinely pay out more than it receives. It’s simple. The patient has to lose. The insurance company has to limit its payouts and restrict its dentists from providing high-end dentistry to its clients. Just like a casino has to win because it sets the rules.

Insurance is usually to cover BIG problems and should pay to cover almost all of your expenses.  Extras cover only covers a proportion of relatively small health costs.  It may be more cost effective to save your Extras Premiums and use the money you have saved directly towards health costs.  Remember that your health funds impose annual limits on how much you can claim.  If you go to a preferred provider practice because they are offering higher rebates, you will reach the limit of what your health fund will cover sooner.   If you are spending more on your Extras Premiums than your receive in rebates it might be time to review your policy and decide whether it gives you value for money.  If you are unhappy with your current health fund, perhaps it is time for a review?

It is hard to see how the involvement of private equity companies in the health sector will be anything but detrimental.

  • At Your New Dentist, we think it is time to refocus on business ethics and the maintaining of integrity to preserve the trust that the public has traditionally placed in health professionals.
  • Your New Dentist is a proud member of the Independent Dentists Network. We are part of a growing network of private practices across Australia who are free from external influence and who are committed to uphold the traditional integrity and care values of past generations who built patient trust.
  • We encourage our patients to turn to the not-for-profit and member owned health insurers. These insurers do not engage in preferred provider arrangements.

The Health Insurance Restricted and Regional Association of Australia (HIRMAA), claims that the Commonwealth Ombudsman data 2010-2015 shows that complaints against the country’s largest for-profit insurers increased by more than 90%. Complaints against HIRMAA member funds during the same period fell by 8%.

HIRMAA’s member funds are growing at twice the pace of the bigger for-profit insurers and are retaining far more policy holders.

Your New Dentist is driven by care not profit. We encourage you to review your current health insurance and make sure you’re getting the best deal possible.

Can you choose your own dentist? Or are you being discriminated against because you would like to exercise your right to choose the provider of your health care.

Your New Dentist is committed to helping you become dentally well again. When you are well, you will have the confidence to take back control of your health and your bank account away from profit driven Health Insurance Companies.


Why We Are Not Preferred Providers

You may not be aware that the term ‘Preferred Provider’ is an invention of the Health Insurance Industry. The term ‘preferred’ has no relationship to the quality of care you will receive. Preferred Provider Schemes are designed to shape consumer behaviour for the benefit of the Corporations bottom line.

We at Your New Dentist are proudly independent. To ensure that you receive personalised, independent care and advice, Your New Dentist has not entered into any contractual arrangements with any Health Funds – we are not preferred providers in the dental industry.

At Your New Dentist we value our relationships with our patients. We are busy because of the service that we provide. Which is a result of not being a preferred provider of an insurance company.

Our industry code of ethics states; “Dentistry is an ethical profession and practising dentists are expected to place the welfare of their patients before any other consideration.”

By becoming a Preferred Provider we would be forced to function on a much lower dollar amount and compromises would have to be made. These compromises might include quality of staff, lower wages, quality of materials, and less funds for staff training and development.

As a result of becoming a preferred provider we would be limited in our ability to provide the sort of service that we love to provide to you. For our industry, the effect of increased private health fund control is eroding the freedoms of choice that dentists would normally have in the way they provide their services.

At Your New Dentist, we pride ourselves on providing high quality personalised care and treatment options that are in your best interests and long term health outcomes.

We are committed to contributing a percentage of all profits back to the local Community through charitable donations and sponsorships – something far more difficult to do as a preferred provider.

Your New Dentist is committed
to making a difference in the world
through the care of others

At Your New Dentist we believe that our view of truly personalised health care is incompatible with the preferred provider schemes.

The Australian Dental Association (ADA) also shares our concerns. Dr Terry Pitsikas AM, chair of the ADA’s Schedule and Third Party Committee, says that although preferred provider agreements have been around for probably more than two decades, it has only been in the past 10 years that private health insurance providers have begun aggressively targeting an increase in the numbers of contracted dentists.

More recently, we have also seen health funds actually owning dental surgeries and this, Dr Pitsikas believes, introduces serious ethical issues.

“One of the problems we have philosophically is whether a health insurer should actually be providing the service for which they are charging a fee, providing a rebate and then charging the contributor a fee to actually join the insurer,” he says, describing a clear conflict of interest that is not visible to the patient.”

A more extreme example, he says, “Is a bookie at a race course who also owns the race course itself and all of the horses, trainers and jockeys. Then add in the fact that they charge people to come and watch and then are instructing the jockeys in how they must ride their horse during each race.” says Dr Pitsikas.

It is not a pretty picture that experts draw of dentistry becoming the plaything of the health insurance industry, whose collective profits in general treatments alone (previously known as ‘ancillary cover’) over the past five years, according to an ADA report, have exceeded $5 billion.

“We field a lot of complaints from members on the basis that health funds are deliberately redirecting patients,” Dr Pitsikas says. “Patients who have had their usual dentist for the last 20 years are being forced by their private health insurer, by their punitive difference and discrimination in rebates between individual dentists, to go to a new dentist they have never met. Just by walking through the new dentist’s door they automatically receive a much higher rebate because this dentist has signed a contract with the health fund. If they elect to remain with their customary dentist, they are not offered reduced premiums because they will receive less rebate. Something just doesn’t add up here.” © BITE MAGAZINE 2015

INDEPENDENTLY providing the right care for our patients

A recent investigative report conducted by the ABC revealed that dentists working for corporate clinics and health insurers are being incentivised to churn through patients and administer so-called “drill and fill” dentistry, according to industry insiders.

Dentistry in Australia is experiencing significant change, unfortunately this is resulting in restrictions on patient freedom of choice for providers and treatment options as health funds are becoming more controlling of their members oral care management.  To contain costs and maximise profits, many Health Funds have evolved to a model where they own their own dental practices. This enables them to keep their members in-house through the vertical integration of all dental services. On top of this, nationwide we have an ever-increasing number of corporate chains buying up multiple practices and operating them as corporate entities.

Dentists interviewed by the ABC say that the current situation is leading to unnecessary dental work, or over-servicing. When the ABC contacted the six largest companies in the industry to find out how they pay their dentists, few would give any details and none admitted to setting key performance indicators (KPIs) or quotas.

The largest player, health insurer Bupa, which has more than 200 dental clinics in Australia, said dentists in its clinics were remunerated based on the revenue they generate, consistent with dental industry practices.

There are also concerns within the industry about the practice of corporate-owned clinics setting demanding performance benchmarks, such as KPIs or quotas, for the younger dentists they tend to employ. This environment is creating a high volume, factory line effect for patients and this in turn is impacting on the quality and value of the treatment provided.

Your New Dentist is proud to be independent

With a genuine passion for dentistry and providing a breath of fresh air in dental care, Your New Dentist joined the Independent Dentist Network (IDN) to enable patients to retain freedom of choice of both dentist and their treatment.

As an independent dentist, Practice Principal, Monica O’Malley is “free to educate patients about their specific health needs and save them money in the long term”. She has made it her “personal and professional mission to be part of the rewriting of people’s dental stories”.

Independent Dentist Network (IDN) seeks to unite all independent dental practices nationwide to preserve patient’s freedom of choice and promote better oral health care for all Australians.

Australia wide IDN’s dentists are committed to building and nurturing long term relationships and providing highly personalised treatment and care. As independent private practitioners, IDN dentists work collaboratively with their patients to achieve cost effective long term oral health that is not limited to health fund restrictions but based upon personalised plans that deliver maximum value.

Independent Dentist Network
“Driven by care not profit”

Reference source:
‘Dentists say targets and bonuses leading to unnecessary procedures on patients’

Health Insurance Premiums Rising Faster Than Wages

Isn’t it crazy that health insurance premiums are going up 54%? Have you ever sat back and thought about just how much value you’re getting from your insurer?

When you work out the cost of your dental checkup over a year, compared to what you’re paying for the Extras so your health insurance will cover it, which is cheaper?

Perhaps looking at an Independent Health Insurer will save you more money than you think.

Watch this video and hear what Dentist Dr Monica O’Malley has to say about Health Insurance.

Visit these links for additional information:

As always, if you have any questions about Health Insurance that you’d like answered, we’re happy to help!

Confused about ‘Extras’ Health Insurance?

The ‘For Profit’ Health Insurance Industry are our friends right?  They want us to be all shiny and healthy just like on their ads. I mean, when I think health insurance I think sandy white beaches and fluffy dogs too… right? It’s just seems all a little bit too good to be true. 100% Better and all that? At what price?

For Profit Health Insurers – For example, BUPA, Medibank, NIB and HCF are private companies and their purpose is to make a profit. Their ideal customer is one who pays their premiums regularly and claims as little as possible. Just like those Gym membership we’ve all taken out and never used (Yep, guilty there too.)

‘Extras’ Health insurance covers things like Dental, Optometry, Podiatry, Physio and Chiro services. All bundled together into a single blob.

When you call a Health Insurers about Extras Cover, it’s not like taking out Car insurance.   When you take out Car insurance you expect to be asked a million questions. How old are you? What make and model of car do you own? Where is it garaged? A million and one questions – all very necessary, so that the Insurer can determine your and therefore – their risk.

But let’s take a look at insurance for your dental health. In order for you to get the best value for your dollar, the level of cover you purchase should logically be based on a risk assessment. Has your health insurer ever carried out a dental health risk assessment?

When it comes to dental health, you are almost 100% in control. It’s not like driving a car where the insurer has to take into account all the other variables on the road that you  and they cannot control. There are a few really easy habits you can develop that will effectively lower your risk for things like dental decay (and therefore the need for fillings for example), or gum disease, or tooth discolouration.

When you are low risk, you need less treatment.  It’s a win: win.  You see the dentist less.  And you save money on dental health insurance you never needed in the first place.

Authorities as diverse as the ex Chief of the ACCC, the CEO of the Private Health Insurance Commission and Choice spokesman Tom Godfrey have all recently criticised health insurance with Choice saying

“Extras cover doesn’t make any sense. Unless you are confident of receiving more in benefits that you’re paying in premiums, you should consider dropping your extra’s insurance. Our analysis of extras cover shows low average payout rate and savings of up to 45% available to consumers who drop it” – Choice Magazine, March 2016.

When it comes to transparency, there seems to be a real problem. For example, Medibank is currently being investigated by the ACCC for misleading customers. They reserve the right to change your Policy’s Terms and Conditions each year and you may not be fully informed of the changes.

Some Health Insurers also contract practitioners in schemes known as ‘Preferred Providers’’, or ‘Members Choice Providers’.  These health practitioners have entered into a contractual arrangement with the Health Insurer.

Under these contracts, your rebate will be affected. If you receive a more generous rebate when you see one of their contracted providers, this means you will reach your annual limit sooner.

What’s becoming clearer to me is that the more confused the customer is,  the more fatigued you become with having to wade your way through the reams of items numbers,  rebates and premiums, the more you fear that your dental health is not predictable and   NOT under your control, the more of a sitting duck you become.

I am passionate about helping my patients to become as low risk as possible and saving them money. The less I have to do to teeth the happier I and my patients are.

It is entirely possible to lower your risk of dental disease to the point where all you need is an annual checkup and clean. At the moment, at Your New Dentist, that will cost you $185.00 annually.  That’s $3.50 / week. In contrast, Medibanks Top Extras Cover for a 25 year old single at the moment costs  around $60.00 a month, or $720.00 / year. Read the fine print to find out what a great deal this is.  The devil is in the detail.

For me, Insurance is about having some back up in the case of an unforeseen event.  It’s different for everyone. Especially when it comes to your health.  We all seem to be being sold ‘bundles’ of all sorts of things these days. I am beginning to feel that today’s ‘ bundles’ are just yesterday’s ‘wool over the eyes’’…

Top Tips

  • If you can, self-insure for extras.  Pop a few dollars away in a savings account each week to cover the costs of ‘Extras’
  • If you need health insurance because you are in a higher risk category – let’s say you play footy. Then check out the Not For Profit Health Insurers.  Search ‘Members Own Health funds’
  • Top Hospital and Ambulance cover is really all what most people need.
  • Put your dental health in the hands of someone who is committed to helping you reduce your risk for dental problems and save you money.

I don’t know about you but my life looks nothing like a Medibank commercial.  I am not very good at running on the sand and my lily white Irish complexion makes me fry in an instant.  My dogs are a bit wonky and slightly badly behaved.  But then again, I am a real person.  I am not perfect but I like asking questions and I like having the choice to control my bank account and my health destiny.


ADA Cautions Senate about Health Insurers –