ADA says PHI can do more


Private-health-insuranceNew data from Medibank Private (Medibank) shows that dental disease was the second most common reason Medibank policy holders needed to attend hospital, accounting for 18% of admissions in the 2014 financial year.

Dr Terry Pitsikas AM, Chair of the Australian Dental Association (ADA)’s Schedule and Third Party Committee, said: “Since Medibank currently has the largest number of policy memberships in Australia, it’s likely that this pattern also applies to other private health insurance policy holders. This is not unexpected as dental after medical is the next highest payout by private health insurance to policy holders.

“The figures released by Medibank relate to policy holders yet despite having cover for dental care, 18% still needed in-patient hospital care for dental treatment. I am concerned that the Medibank figures might be inflated as Medibank insists on restricting rebates to only two hour dental theatre cases. Restorative cases often require more than two hours of treatment so one has to wonder if the figures also include readmissions for unfinished treatment. The lack of additional rebate for longer duration cases is unfair to policy holders. Many other insurers do not apply this two hour limit for rebates. The risk of a patient needing a second theatre session because of a private health insurer’s rule is hard to justify.”

In spite of continuous premium increases, private health insurers have for years failed to increase the level of rebates policy holders receive for preventive and restorative dental treatment such as basic scale and cleans. The gap between premiums paid and rebates is ever increasing. Private health insurers such as Medibank also place limitations on the frequency of treatments and the actual services rebated by them, such as oral examinations and preventive treatments. For the last three years private health insurers have averaged well in excess of $1 billion surplus per annum for general treatment policies and dental care represents about 52% of general treatment services.

PHIs place annual monetary limits on the amount of rebates policy holders can receive, even though no such limits apply to rebates for medical services. For some services, policy holders are restricted to a “once in a lifetime” claim even though full premiums are demanded annually by PHI even after a claim has been made.

Dr Pitsikas continued, “Restricting policy holders’ access to prevention does not make oral health problems go away. Medibank’s own data shows this.”

Poor oral health has been linked with chronic disease, such as diabetes and cardiovascular disease. This is particularly concerning considering that nine in 10 deaths have chronic disease as an underlying cause.

“Dental disease, such as caries and gum disease are in many cases preventable. PHI need to better support preventive and restorative services so that their policy holders not only avoid dental disease, but also improve their chances of avoiding chronic disease and the hospital too. Many of the restorative issues could be nipped in the bud if detected earlier and avoid many of the hospital admissions”, Dr Pitsikas concluded.

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