Rebates & Gap Payments

When you first take out private health insurance, the expectation is that you will receive rebates that cover a sizable proportion of your expenses.  But the reality is that rebates for dental services, which fall under what's known as 'extras' cover, rarely cover anything like the full cost of a treatment.  Despite claims of 'no gaps', may funds only cover on average about half the cost, leaving you to cover the gap that remains.  This is most evident in your annual cap limits which are quickly exhausted and don't come close to covering the full amount you've spent on dental treatment.

The gap between what you pay for treatment and what you receive back from your find is largely-influenced by the rebate percentage set by the funds.  Yes, dental fees are a factor but only in so far as fees vary between dentists, meaning that the set percentage you receive back will also naturally differ.  Also it matters whether your dentist works in an independent practice, as the majority do, or whether they are in a contractual relationship with your insurer.  By and large your dentists has no control or visibility over the rebate amount your received.  So when your insurer tells you that you are getting back such-and-such an amount solely because of the fees charged by your dentist, you should treat this reasoning with the healthy degree of scepticism it deserves.

If you feel like you are being short-changed in some way by your private health insurer then you should check out other funds as well as making a complaint to the the Private Health Insurance Ombudsman.

You may also visit ADA time2switch campaign.