PRIVATE HEALTH INSURANCE, GAPS and BULK BILLING
This page will hopefully demystify some questions you may have about the various terms about payment options you may have heard when you visit the dental office.
There are 2 ways the cost of your treatment can be subsidised:
- Private Health Insurance (PHI)
- Bulk Billing - with MEDICARE
Private Health Insurance (PHI)/Health Fund
A Private Health Insurance (PHI) helps cover the costs for some of your health treatments, so that you don't have to pay out the entire bill yourself. Private Health Insurances are usually divided into:
- Hospital cover, and
- General or Ancillary cover (e.g. Dental, Physiotherapy, etc...)
Some PHIs cover the whole cost of your treatment, and others have a limited cover. The amount covered by your PHI depends on:
- the PHI you are with,
- the type of cover, and
- level of your cover
what is a 'gap'?
If your Private Health Insurance (PHI) covers you for dental treatment, there will usually be a limit on the cover every year. Different PHIs cover differently for different items/codes of treatment. If the dental practice charges more than your cover, you will need to pay the GAP, or excess.
Some PHIs determine the price of the treatment, and can have a different cover if they have a certain contract with the dental practice. You may know this as a 'Preferred Provider'. Different PHIs may use different terms for it.
John Smith needs to get a CheckUp. He is with Private Health Insurance (PHI) ABC. He gets a quote from 3 dental practices:
Charges $120 for a CheckUp (Code 011).
PHI ABC covers $35 for Code 011
The GAP (excess/out of pocket) payment is $85
Charges $120 for a CheckUp (Code 011), but has a NO GAP promotion that month for checkups.
PHI ABC covers $35 for Code 011
The GAP (excess/out of pocket) payment is $0, because of the promotion.
Is a preferred provider for PHI ABC, charges $145 for a CheckUp (Code 011).
PHI ABC covers $50 for Code 011
The GAP (excess/out of pocket) payment is $95
Always be careful to check your limit, and know what your PHI covers, as not all items may be covered.
Usually, YOU will need to call your PHI to find out the amount covered for each item for your treatment.
Aperture Dental Practice is a Preferred Provider for NIB and HCF.
BULK BILLING - with Medicare
There can be some confusion between the term 'NO GAP' and 'BULK BILLING'. As mentioned above, the GAP is usually associated with the excess payment when using a Private Health Insurance (PHI).
A procedure or treatment is BULK BILLED when it is subsidised completely by MEDICARE. In dentistry, bulk billing only occurs in Public Dental Clinics, unless a scheme exists to outsource the treatment to Private Dental Clinics. Aperture Dental Practice is a Private Dental Clinic.
The following are the current bulk billing schemes outsourced to Private Dental Clinics:
You must also be eligible to receive this benefit.
AM I ELIGIBLE?
For adults to be eligible, you must be a Queensland resident, and where applicable, in receipt of benefits from:
- Pensioner Concession Card issued by the Department of Veteran's Affairs or CentreLink
- Health Care Card
- Commonwealth Seniors Health Card
- Queensland Seniors Card
If you are eligible, all of your dependents named on the card are also eligible for free public dental care. Also eligible is any child in the guardianship of the Director-General, Department of Families, Youth and Community Care.
I AM ELIGIBLE. WHAT DO I DO NOW?
The Oral Health facility and dental services at the Logan Hospital has CLOSED and shifted to the local Community Health Centres. The following are the closest Oral Heath facilities to our clinic:
Logan Central Community Health Centre
97-103 Wembley Road, Logan Central - view on map
(07) 3290 8900
Browns Plains Community Health Centre
Middle Road and Wineglass Drive, Hillcrest - view on map
(07) 3412 3100