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What is a Health Fund Preferred Provider?

A preferred provider or preferred practitioner in an Orthodontic or Dental practice contractually bound to a Health Fund’s conditions to deliver services at a fixed rate. (Mainly for the increased revenue for shareholders). This rate is then matched by their rebate allowing the health fund to advertise that they have ‘no out of pocket expenses’ or ‘reduced out of pocket expenses’ so long as you see one of their preferred providers.

A health fund will often specify a list of providers that they ‘prefer’ you to go to.  If your Orthodontist or Dentist isn’t a preferred provider you can still attend them for treatment however the full fee they charge will not be covered by your health fund rebate. This means that you will have some out of pocket expenses.

We accept and understand in life, that costs and inflation fluctuate from time to time. We also understand that not all providers of any product or service deliver the same quality.  If you are contractually obligated to charge a fixed rate without regard to increased prices or inflation you risk compromising quality to meet the cost specified by the health fund. 

Some health funds now offer a higher rebate if you use one of their preferred partners. This is often a tactic Health Funds use to prove to their contracted providers that their alliance brings additional business. The only measure used by Health Funds to determine if a practice can be a preferred partner is cost.

I would question the ethics health funds use in regard their operational tactics towards other Practitioners as well as their clients. See ABC Background Briefing of 30 Jun 17 “Dentists say targets and bonuses leading to unnecessary procedures on patients”

Is Dr Vaughan a Health Fund Preferred Provider?

No. Dr Vaughan will not compromise on quality; therefore he will not become a preferred provider to any Health Fund. 

This does mean you may have some out of pocket expenses as your health fund’s rebate may not cover the full fee, however this allows Dr Vaughan to ensure that the main focus is on providing you with the best possible quality treatment and service rather than simply meeting costs.