Same Dental Items at The Same Clinic Quoted Different Price for Difference Insurance Provider

Meovel on 07/01/2022 - 23:02

I previously switched from Medibank 75% extra to Bupa 90% extra, and noticed that items on my treatment plan at the same clinic all raised. I.e. I'm getting less than 15% more covered due to the rise of quoted prices.

This year when I switch to another provider the price for the same item raised by another $200 making me annoyed.

A friend also told me he was attempted to charge $240 for an item once and since his insurance was out of limit he decided not to go through insurance and was only charged $120.

I feel so much intransparency in this process, an insurance provider can increase the quote of an item (and you have no way to know beforehand) that makes a higher-cover policy essentially cover less :(

Health & Beauty

Comments

  • Quantumcat on 07/01/2022 - 23:21

    Get quotes before you tell them you are insured. Then make them stick to the quotes.

    • Meovel on 07/01/2022 - 23:26

      So the price is set by the clinic not the insurer? They intentionally made it blur to me by saying "different insurance may have different quotes".

      • Quantumcat on 07/01/2022 - 23:56

        Isn't it the clinic that charges, and the insurance covers some percentage of the amount?

        • Meovel on 08/01/2022 - 00:14

          Yes that makes sense.

  • slknv on 07/01/2022 - 23:58
    +6

    Ex clinical advisor to health funds here. Many dental clinics have contractual agreements with certain health funds to charge their specific health fund members a set fee which is dictated by the health fund. This fee schedule may vary even within a health fund depending on the level of cover a member holds. This is assuming the clinic is a “preferred provider”. If the clinic is independent of the health fund, they may set whatever fee they decide to, and the benefit (if any) payable by the health fund is out of the control of the clinic.

    And both Medibank and Bupa suck BTW. Or at least suck more than most health insurance.

    • Meovel on 08/01/2022 - 00:13

      Thanks for the information, this explains the quote difference when I switched from Medibank to Bupa.
      This time I'm using an independent insurer and get an even higher quote … means Medibank and Bupa actually negotiated something lower and I think I should look for quotes from other clinics in this case :(

    • Meovel on 08/01/2022 - 00:19

      By "Medibank and Bupa suck" did you refer to their contractual price being higher than original clinic charge or being incompetitive compared to other health fund?

  • Benoffie on 08/01/2022 - 00:45
    +1

    Very common. Cousin is a dentist. When I had Bupa extras, she'd charge their fee and my gap was $149 give or take.

    Dumped the extras and now I pay…. $149 give or take.

    Cash is king in dentistry.

  • arkie0 on 08/01/2022 - 02:07

    Private health fund covers a set amount per dental/physio/therapies item, this can be different between different extras covers and also different health funds. Usually "Top" covers rebate more per item, but not always some items can be the same rebate regardless of cover.

    Eg. Medibank might cover $100 for a clean/scale, $80 for a filling on the essentials/midrange cover and 120 for a clean/scale, $90 for a filling on their top cover.
    whilst Bupa might cover $80 for a clean/scale, $100 for a filling on their essentials/midrange cover and $100 for a clean/scale, $130 for a filling on their top cover.

    Now the Dentist can charge whatever they like - they usually know what rebates are paid by various health funds, and will usually charge you above.

    Most PHIs have a network of preferred providers, at those providers they charge you a fixed amount over the rebate to give you a set 80%.
    Eg Medibank might cover $80 for a filling, the dental provider must charge you $100 in total / $20 gap to give you a guaranteed 80% back.

    • xsacha on 10/02/2022 - 15:22

      So effectively if you pick 50%, they charge $160 ($80 gap) and if you pick 80% cover, they charge $100 ($20 gap)?

      So PHI coverage doesn't change (or at least not much) but the dental clinic just charges more if you have less coverage to make up the percentage?

  • avoidfullprice on 08/01/2022 - 08:33

    Legit reason: clinic is part of smile network, and if insurer is part of it as well, you get a discount

    Other reason: the clinic wants an amount for your visit, set higher $ when lodging hicaps so they claim more $, and you pay less or no gap.

  • KaraZorEl on 11/02/2022 - 09:41

    We had HIF extras (Special option) for almost a decade. We used to get twice a year scale and clean and there was never any out of pocket even when claimed at different dental clinics. We stopped extras cover a couple of years back and paid cash approx $180-$200 for a clean ($85 for child). Honestly, with dental itself the approx $800-$900 annual premium (pre-2019 rate) paid for itself.
    Looking back at my HIF claim I see that there was always a gap between the fee and benefit but we never ever had to pay out of pocket!

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