<Ancillary Insurance Cover For Oral Surgery>

Medicare for certain areas of dentistry and specialist dentistry such as through the EPC programme, the Cleft Lip and Palate Scheme... Or Veteran's Affairs dental benefits for war veteran's,
Out-patient and In-hospital Oral Surgery coverage through Ancillary Health Insurance,
In-hospital Maxillofacial Surgery through Hospital Insurance coverage, and Medicare, and
Out-patient Maxillofacial Surgery through Medicare.
Net Medical Expenses Taxation Offset.

There are two distinct types of private health insurance... Hospital (click here) and Ancillary (extras).

This page explains only how Ancillary Health Insurance works, and which work best in specialist oral surgery circumstances.

If you have a Health Insurance Policy, remember that there are two types of private health insurance (hospital , or ancillary), and these are not the same thing.

Most people are unaware of the differences between these two health policy types, and even the call centre operator for your health insurer may not be fully aware of the different benefits and distinctions your individual health care insurance policies provide.

Usually "extras" insurance packages include coverage for other ancillary health services, such as pharmaceutical, ambulance, physiotherapy, chiropractic, optical or dental treatment.

The government provides a 30% top up to your insurer in the event of your signing up for a policy. Meaning, if you pay say $1,000 for your extras package/annum for your family, then the government will pay a further $430 to the insurer, simply because of your signature (30% of $1,430 is $430).

Broadly speaking, annual insurance reports may state things like "91% of members contributions were returned in rebates during 2007". This sounds great on paper, which means on average that if you paid for a $1,000 ancillary health care cover, you would have had returned $910 in rebates. Still a 9% loss to you, but not too great, and there was peace of mind that you were at least partially covered for extreme dental costs.

The reality is there was another $430 paid to the insurer by the government (through the 30% Government contribution scheme), which means in real terms the insurance company received your $1,000, paid out $910, and kept $520 (which includes the $430 the Government paid them through your hard earned taxation dollar). A great profit for the insurer, but not so great for you.

We think some Ancillary Health Insurance policies are a rort, and so we don't recommend taking out cover without firm guidance by a Health Insurance Broker. Some insurance companies, especially Mutuals, or not-for-profit organisations, and especially some of the smaller well established funds appear above board, and offer genuine, high rebate services to their members.

This practice views ancillary dental insurance in a broad sense as not cost effective for any person, and in general (both community wide and individually) increases the cost of dental care over a lifetime. Nevertheless, many people carry ancillary dental insurance in the hope that their policies may protect them, or cover them in the event of extreme dental care costs. Extreme dental care costs are rare, and for the most part, greater benefits may be had through other rebate schemes.

Remember that extreme dental costs are rare. If you have perfectly straight teeth (because you had braces as an adolescent), you have no wisdom teeth (because they were prophylactically removed), and are at low risk for dental decay (because you have yearly checks ups with your dentist, and you regularly floss and brush), then you are likely to never ever require any procedural dentistry in your life. It's far cheaper for you (in these circumstances) to simply pay your way through your dental life.

In order to limit payment rebates to the lowest possible level, and to maximise the profit to the insurer, private insurance call-centre operators may direct you to see their own "preferred" general dentist, and not a specialist oral surgeon, regardless of whether your needs are specialist level or otherwise.

Some may also direct you to their "Insurer Name" Dental Centres, which for the most part are not even owned by the insurer. These centres are usually owned by other corporations, or even private entrepreneurs, providing cheap, low service delivery of health care, & by dental professionals who are usually backpackers, or overseas graduates... Usually, at the lowest possible clinical denominator.

We recommend that if you seek general dental care, then it should be by a person of your own choice (not forced upon you by a disembodied voice in a call-centre), who owns their own practice, and is likely to be around for the next twenty years. This way treatment is longitudinal, whole, and personal... And if you have a problem, then you can rely on that practitioner to be available to help you, day or night, weekday or weekend.

Firstly, all oral surgery can be provided either by general dentists or oral surgery specialists. Your ancillary health care policy should cover you for dentistry, but it may have clauses and restrictions on what types of dentistry are provided, or who may provide them.

In New Zealand, there are greatly different rebate levels depending upon whether your oral surgery is conducted by a general dentist, or by a specialist oral surgeon. In Australia, some policies offer slightly higher benefits for specialist oral surgery.

The majority of Australian funds do not make a distinction, and some funds may preferentially direct you to a general dentist for specialist oral surgery to limit their rebate liability.

To see what procedures are considered specialist oral surgery and those which are considered specialist maxillofacial surgery... Click here.

Your relationship with your health provider is your own. Ocean Surgical has no contractual or monetary relationship with any of the Ancillary Health Care Funds.

We do not recommend any insurance company over another. We do however recommend that you seek the services of an Independent Insurance Broker before engaging a Health Insurance Company for Ancillary Health Insurance benefits.

These are some of the insurance companies that offer dental care coverage through Ancillary Health Insurance Policies (with a superficial explanation of their benefits and coverage). For a more full explanation, you should call the insurance office directly. We do not recommend any of the companies listed, and they are ranked randomly. We advise that if we have missed any insurance company, it is not because we do not recommend them, but because we do not know of them, or that these missed companies do not offer Ancillary Health Insurance policies. If any of the information is out-dated or incorrect, please call the office, and we will correct the information immediately.

To compare, we have chosen the highest level "Extras" package from each of the following insurers. Policy costs are calculated for a family, with the parents aged 35-39, and without an associated "Hospital" package.

The 30% government contribution is not included, so you should remember that whatever you pay, the insurance company gets another 43% of that amount from the Government (e.g., 30% of $1,430, is ~$430)

This company is the best known health fund to the Hunter and Newcastle region. Families pay ~$1,000 (plus another 43% government contribution) (generally considered the cheapest), and gain an approximate benefit of $450/annum for specialist oral surgery (12 month wait), or $350/annum for oral surgery by a general dentist (generally no wait). There is an extra $60 per prescription rebate also available, which makes oral surgery a little more affordable.

It is not certain whether reaching the specialist oral surgery level will affect rebate levels for other dental services under this policy. The policy is cheap, and generally returns the contribution back to the client through small rebates. Sometimes the call centre staff direct clients for specialist oral surgery to the NIB Dental Care Centre. This is a practice which we feel is unethical (as they do not employ any specialist oral surgeons, and the centre is not even owned by NIB), but to be fair, they claim to have tried to stop this practice in recent times.

Probably the second most popular ancillary health fund. Policies cost around $1,300 per family. Benefits are $500/annum/individual for oral surgery (regardless of being by a specialist or by a general dentist), and a 12 month waiting time applies. It is not certain whether reaching the oral surgery level will affect rebate levels for other dental services under this policy.

We think HCF are relatively more expensive for little rise in actual benefit when compared to other cheaper funds.

Family membership is ~$1,300/annum, and family members receive a maximum of $2,000 on major dental (which presumably covers specialist level oral surgery), with no annual limit for general dental. There is an initial twelve month waiting period.

This agency appears superficially to give a higher rebate to their members, but there are "catches". If you see a "Members Choice" general dentist (these are non-specialists who have agreed to charge a set fee for wisdom teeth), then they must charge $240 for a set fee rebate of ~$190. Which leaves you out of pocket ~$50 per tooth.

MBP do not seem to have any preferred specialist oral surgeons, and make no distinction between specialist oral surgeons and general dentists in performing specialist oral surgery. So if you have to see a specialist oral surgeon, because you want to limit your oral surgery "risks", then your rebate will be a little lower at $160/tooth. By preferentially directing their clients to general dentists for specialist oral surgery, we think we are setting their clients up for over servicing, whilst exposing clients to higher operative risks.

The policy seems to provide better rebates for relatively similar policy costs as other middle road policies, but we think that MBP should rethink their rebate policies.

$1,600/annum for a family. $196/wisdom tooth (a set of four would give you a rebate of $784). $1,000 per person/annum maximum limit on major dental. 12 month waiting time. They don't give higher rebates for specialist care over general dental care.

We think this the star policy, but it is expensive. If you are looking to pay for specialist orthodontic treatment, and specialist wisdom teeth removal, and have a number of children, and maybe an implant or crown for yourself, this seems an ideal policy that can greatly reduce high collective family dental costs.