Medibank private extras cover....members choice dentists

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I have extras cover with Medibank Private and if you visit one of their Members Choice dentists, you get free checkup, discounted rates etc. I just got this email from Medibank today…

our dentist is *no longer part of Members’ Choice.
We’re writing to let you know that Jin Chan Dental is no longer part of our Members’ Choice Network.
The good news is, there’s another Members’ Choice dentist nearby. You can find your closest Members’ Choice provider by visiting medibank.com.au/provider .
Why choose Members’ Choice?
Our Members’ Choice Network generally provides you better value because we’ve negotiated special prices with these providers and 100% back on an annual dental check-up and clean each year.#
Prefer to stay with your current dentist?
That’s absolutely fine, we’ll continue to pay benefits towards your dental visits based on your cover type and limits. However, you may have additional out-of-pocket expenses to pay. To find out more about your cover download the Medibank app, visit medibank.com.au/members or call us.
To see more details on the dentists you’ve visited which are no longer part of our Members’ Choice Network please see below.
As always, we’re here to help
If you have any questions, feel free to call us on 131 680 between 8am–8pm Monday to Friday, or 9am to 4pm on Saturdays (AEST).
The team at Medibank

I rang my dentist as it sounded like they had cancelled it themselves. The dental practice only heard about it today and said Medibank was forcing it onto them, as the principal dentist had cut her hours back. It appears Medibank doesn’t treat the smaller local practices with a high level of importance and are only interested in the big ones. My dental practice is starting a petition and has said they will honor existing patients with the Medibank rates.
I know I have the option to visit any dentist I like, but I specifically chose this one as it was on the preferred network and I got better rates. I left my previous dentist of 20 years, as he aligned himself with BUPA…giving those customers better prices, but ignoring my loyalty.
I feel like I’m being pushed around by the Health Insurance companies!

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Any fund that features networks of providers with no-gap or special fees should consider changing as this is an introduction into the American system where the networks of providers are those willing to sign up for the offered fee structure and who can process enough patients to keep the funds overheads in paying as low as possible. In the end the accountants are the only ones who matter, and those who are in or out of any particular funds network will change from time to time, almost always because of financial reasons between the provider and the fund.

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I was tempted to save the dollars, but have put off joining the queue at the Health Fund nominated provider. Locally the options are limited (zero) with one only in the next town, or a 30-40minute highway drive each way. What odds they will refuse all coercion to be part of the health fund circus. It’s reassuring that others are also resistant to change.

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As you indicated, it is likely the dentist cancelled their listing as a member choice dentist as they no longer wanted to offer no gap coverage to Medibank customers. This couod be done for a number of reasons, which the dentist can only explain…if they chose to tell the truth.

We go to a member choice type dentist and they charge our healthfund over $200 for a 20 minute check up and x-ray. I assume they do an x-ray as this is covered by the fund and the more x-rays taken, the machine is paid for earlier/profit made.

If dentists charge health funds $200 for each visit, not a bad income compared to GPs which get about $35 per consultation if bulk billed.

We also get two checkups per year (at the same rate) which I personally think may be a little excessive to someone with no problems or good teeth. Anyway, while we get 2 per year, happy to oblige as it makes use of our insurance…but in the end potentially places upwards price pressure on premiums.

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@phb perhaps you misread the intent of the OP’s sentence

From my reading it wasn’t the business who cancelled their membership but rather it was medibank who removed them as the principal dentist had reduced their hours “as the principal dentist had cut her hours back”. As to the no gap issue @Suzique also noted “[the dentist] has said they will honor existing patients with the Medibank rates”.

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I possibly did because what was written, some things don’t make sense.

Firstly, dentists set their on fees and charges. It is the dentist which would chose to charge the schedule fee for checkups which are nominated by any of the health insurance companies. If the dentist decides to charge more than the schedule fees, then it is the dentist choice and not the health insurance company. If the dentist charges more than the scheduled fees, then I would expect that Medibank would remove the member choice status as the dentist no longer is a no gap dentist.

If Medibank sets the fees for any dentist, this would be a grave concern and would amount to collusion. This would be something that action would be taken by a number of parties inducing the Australian Dental Association and also the ACCC. I would eat my hat if this was the case as it is unlikely it could be hidden so that every dentist (including member choice ones) kept the information confidential.

Say that the dentist didn’t change the fees and it was still charging the schedule fees. Assume that Medibank decided for some reason to remove the member choice status (say they us a ballot and allocate it to a limited number of dentists in a particular region). Even if the dentist no longer could market itself as a member choice dentist, if it charged the scheduled fees it would still be a no gap dentist for customers (namely, customers would not be out of pocket for a standard check up consultation). It should be able to tell its customers that even though they can’t advertise themselves as a member choice dentist, the schedule of fees would still be charged meaning no change from a customer point of view.

I can’t see a company like Medibank restricting the number of member choice dentists as the more they have as member’s choice, the more beneficial it is for Medibank and its insurance policy holders.

The dentist we use is a small independent dentist in Brisbane which is a Medibank member choice dentist (as well as a no gap dentist for a range of other health insurers). There are also other similar independent dentists in our area with the same status. The argument that Medibank only wishes to deal with the big ones doesn’t seem to hold up.

Another reason is that Medibank may have received complaints or information about the dentists they they have been charging for services not rendered, but being billed to Medibank. I would expect that Medibank would take action in such cases to protect its own interests and reputation in such cases.

I personally think that the dentist may have decided it didn’t want to charge the scheduled fees, notified Medibank which then advised they would lose member choice status. They are possibly blaming Medibank for action they took themselves to lose the member choice status. They are possibly honouring the scheduled fees (no gap) for existing customers so that they don’t lose their client base, but new customers may be changed more than the standard fee.

BTW, just checked the fees from out recent checkup and it was $225 which included two x-rays (on for either side of the mouth). The consultation went for 20 minutes so one could assume that they book a patient every 30 minutes (to allow hygiene practices and setup for next patient)…

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Funds with networks work in a very straight forward manner. It is or is based on the prevailing US model to keep overall costs down.

In the most simplistic sense they recruit providers who are willing to work for a contracted rate, less than their posted rack rate. In return that provider gets customers sent by the fund so in theory is always booked ahead and busy.

Collusion? Not at all. Anyone not in the particular fund pays whatever the provider asks as their rack rate. There is an analogy to bulk billing. A provider can chose to accept that amount for his/her services, or charge more. In the case of network providers they agree to a contracted amount, they don’t get together to set that. It is possible each provider has their own contract with their own contracted rates with each fund.

It is a case of all business is not good business. They seek to have as many providers as possible so long as it is profitable business and their networks are being patronised to a high level. If the providers are not getting the business they would be less inclined to contract the lower payments they would receive by being ‘in network’.

Not being privy to the decision process it is easy to question who did what to whom.

ps. I remember a lab test in the US done in the late 90’s. The rack rate was about $25 and the lab was paid about $3 by the insurance company, accepted as payment in full. That is the model the insurance companies love.

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We had a dentist for many years until they retired and sold the practise. The new owners became part of the Medibank network, but every single time we went for a scale and clean, another filling or crown or … would be found to be required. We went to another non-network dentist for a second opinion. Haven’t needed any work done for the last 2 years. mmmmm. Might cost us more than their network dentist, but less stress on the wallet and the teeth in the longer term.

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Hi Yannie - hmm this sounds VERY suspicious… I agree with your thoughts that less stress in the longer term is the way to go, and give Medibank a very wide berth… thank you for posting…!!

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