Extras Health Insurance (Dental). Can Someone Please Break It down for Me

Lp1723 on 10/03/2022 - 17:43
Last edited 11/03/2022 - 18:19

Edit #2: I've figured it out through talking to multiple clinics and health insurances. The 60% is on top of the already discounted preferred provider rates. So $131 is before you swipe the hicaps machine for your 60%

Edit: if anyone can recommend a health insurer for just dental fillings most value for money pls let me know what insurer and plan. Only interested in extras atm as I earn <90k

I've been calling health insurance companies and dental clinics and they can't really give me a straight answer.

With basic extras it's 60% off (up to a certain limit, e.g. $500 pa) with no hospital.

I've been quoted the same numbers so far for two different "preferred provider" clinics for the dental work that I want done.

For item 531 (single surface filling) it's $200 non-insured or $131 for the insurance (NIB or Qantas) cost.
For item 533 (multi surface filling) it's $330 non-insured or $204 insured.

So how is it that they keep saying it's a flat 60% off when it's clearly only about 30% off with preferred providers (lord knows what it is with unpreferred providers), and there's no further discounts to be applied on the "health insurer rate" for these services.

Shouldnt it be $80 for item 531 and $132 for item 533?

I'm just not understanding, and can someone with dental experience please help me understand how these health insurances work.

Health & Beauty Health Insurance Insurance

Comments

  • jasonlah on 10/03/2022 - 17:58

    Your problem is with your insurer, not the dental clinics (who have no control over the amount that the health fund pays back). You should direct your queries to NIB or whoever you're with… (likely they will then blame the dental clinic lol)

    • p1723 on 11/03/2022 - 00:42

      That's exactly what they did. They said it depends on the dental clinic. Yet they have a dental clinic themselves for their health insurance. So you'd think they know about their own clinic

  • holdenmg on 10/03/2022 - 17:59

    https://www.hif.com.au/health-insurance/extras-cover/dental says it well and tells you in plain language the amount according to the extras table for 531.
    Simple Extras is 60%, Essential Extras $79.90, Advanced Extras $87.20, Top Extras is $92.55

  • slknv on 10/03/2022 - 18:06
    +1

    Ex health fund dental advisor here.

    Every single private dental clinic can set whatever "regular" fee they like. There is not "set" or schedule fee, regardless of what clueless health fund phone consultants will tell you. A health fund will aggregate some fees surveyed, pick a number and then assign that fee (which is a % lower than the average) to dental clinics who are their "preferred providers". Then their marketing department will take that discount, multiply it by some magical amount and tell you you're saving "60% on regular fees".

    On the topic of "unpreferred providers", health funds in general are trying to reduce the number of "preferred providers" under their umbrella. Very few dental clinics who apply to become preferred providers are approved in metro areas as there's an oversupply of private dental clinics. IN regional areas it's the opposite problem for health funds - not enough dental clinics, and the ones which are there, are busy enough they have no need to become a preferred provider. Don't mistake "preferred provider" for "better provider" either.

  • AustriaBargain on 10/03/2022 - 18:09

    Even public dental is working this same way these days, effectively anyway. There's so many patients trying to access the system that they just give you a voucher for basic/essential dental services, but dental clinics can cheese whether they opt into the voucher program or net, effectively making them "preferred providers". I've also seen smile.com.au which seems to be their own dental insurance system giving you discounts at their own preferred providers.

    Anyway, my dentist told me that the co-pay is different for each major insurer so they can't tell you what your exact co-pay will be without knowing who your insurer is and putting it in the system to check. You don't make it clear if you already have insurance or not, but if you don't then doesn't dental usually have a waiting period for new members?

    • p1723 on 11/03/2022 - 00:47

      Yeah I've never had private and now I need a bunch of dental fillings (supposedly) so I'm only interested in extras (no hospital). I'm just trying to find a way to identify the best value for money and these funds are making it difficult.

      I don't mind waiting the 2 months as I'm in no urgency however I'm not up for having surprises on the day about whether it's going to be $300 or $1000 out of pocket depending on the fund if you know what I mean

  • WreckTangle on 10/03/2022 - 19:52

    I just get basic dental insurance and go to a no gaps private clinic.

  • Benoffie on 10/03/2022 - 22:33

    This is why I dumped all Extras. If my dentist is anything to go by (and I know them well, we're family), they jack up the price for insured. It's that simple.

    You are getting 60% back, but it's off a higher fee.

    For example, when I had Extras, I would get the same check up, hygienist etc stuff done. HICAPS go through and 'that'll be a gap of $140-160' without fail.

    Dumped the extras - 'that'll be $140-160'.

    • p1723 on 11/03/2022 - 00:50

      Alternative looks to be out of pocket $600 for 4 fillings. Health insurance looks to be the better option at the moment anyway. Even if it's a $100 saving it's a $100 saving

      • Benoffie on 11/03/2022 - 01:21

        You need to factor in the monthly costs to gain those savings. For us, it was $110 per month. It cannot be looked at by individual item numbers but yearly vs use etc

        • p1723 on 11/03/2022 - 08:11

          About $1 a day for most of these I'm looking at. So $60 before I can claim it and then quit after

          • holdenmg on 11/03/2022 - 08:38
            +1

            @p1723: I noticed https://www.medibank.com.au/health-insurance/extras-cover/ is offering Extras cover and waiving the 2 and 6-month wait on Optical and General Dental with the use of Promo Code EXTRAS
            So on Healthy Start Extras that is $500 combined limit for $6.11pw or Essential Extras 75 is $750 combined limit for $9.24pw

            • p1723 on 11/03/2022 - 15:14
              +1

              @holdenmg: Mate you're a winner. If my calcs are right, the medibank 75 turns out to be better than the other two I was considering

  • avoidfullprice on 10/03/2022 - 22:35

    What if there are more than one cost involved, such that the non-insured total cost are

    Single surface: $115 (item 531) + $85 (??)

    Multi (three) surface: $210 (item 533) + $120 (??)

    Your benefit for item 533 ($126) is double of 531 ($63).

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