Frustrating day at the dentist today, that left us with more than $300 in bills for three regular checkups, despite having dental insurance.
Australia has universal health care called Medicare. This means everyone who is a citizen or permanent resident can get basic health care for free, and it's paid for by taxes. Kids, if their parents or guardians pass a means test, get free basic dental services, capped at $1000 every two calendar years until they are 19. Grownups have no dental benefit through Medicare.
If you want dental insurance, or if your kids don't qualify for the Medicare dental benefit (ours don't), you get private insurance. Our private insurance is called Medibank.
When I went to make checkup appointments for the kids and myself, I called Medibank. I asked them if I could go to any dental provider. They said, "Yes, just make sure they accept Medibank." So I investigated all the dentists in our area, found one that sounded the most qualified, and called her office. Yes, they take new patients, yes they take Medibank. Done! Or so I thought.
We went for our appointments today. The dentist was lovely and seemed very smart. No waiting in the waiting room - straight to the appointments. Isaac needed lots of calculus removed from his teeth. Ruth has three cavities and will need fillings. I will need two sealants. I blame the Tim Tams. Then the fun began . . .
Ruth couldn't get her teeth filled with this dentist, because this dentist doesn't do fillings on kids. She will need to be given gas, and gas is only given by one dentist in the practice who is booked through June and doesn't like seeing kids anyway. She'll refer me to a specialist. But I could make an appointment for my sealants with the same dentist we saw today. It will only take a half-hour.
I went back to reception to finish up the paperwork. Insurance cards are checked after the appointment, not before. The receptionist ran my card, then said, "The gap is going to be $300 for today." I was completely confused. I asked why the entire appointment wasn't covered, because when I made the appointment they said the dentist took Medibank.
"Yes, we take Medibank, but we're not a Medibank provider." And suddenly it's clear. It's the HMO system all over again, just with different vocabulary that I was unaware of that now cost me $300. We went to a private dentist. Private (not provider) dentists get paid a pre-arranged amount for basic dental services from the private insurance, but unlike the U.S., instead of the dentists simply lowering their prices to what the insurance will cover, the patient pays the gap. And in the U.S., providers either take your insurance or they don't. Here, they take it or they sort of take it. After exploring more, I've discovered that had we gone to a Medibank provider, they would have covered 70% of our bills, not less. There still would be a gap to pay, but a much smaller one.
The receipt was full of all the details that added up to $580, of which insurance paid $275. Included in the details was an extra $50 for scraping Isaac's teeth. Tartar removal is apparently not part of the cleaning. This annoyed me as well, for the polishing we got was pretty perfunctory, and the dentist didn't floss. Interestingly the dentist did the cleaning; the hygienist basically just held the suction tube and took notes on gum status.
I'm mostly mad at myself for not knowing what questions to ask to avoid this situation, and maybe the Medibank agent, for not making the whole process clearer for me. I can't be the only immigrant who purchases private insurance and is confused by the process, and I speak English - many immigrants don't.
The receptionist had said she would check on the cost of my two sealants and get back to me. When she called me back, she said the dentist was going to discount my sealants so they would only cost $260. And she had overcharged something on Isaac's checkup, so they would deduct $26. Plus Medibank would pay for part. How much of it would they pay for? The receptionist never knows until she puts my card through for the services after the services are performed. They have an app to figure out the final cost but it never works. I called Medibank to ask, and they said they couldn't tell me without a procedure code from the dentist. "A filling in a kid's molar" isn't specific enough, apparently.
I've found a new dentist who will fill Ruth's teeth who is a Medibank provider. They don't give gas and think it's ridiculous to do so; they use an injectible analgesic and kids are fine with it. Ruth goes in on New Year's Eve day.
When running my experience by other expats, they nod in understanding. Almost all of us waste money at the beginning of living here, simply because we don't know better.
I'm curious to know how this is handled in other national healthcare countries like Canada or Israel or GB. If any of my friends want to add comments, they would be most welcome. In theory, I am a huge fan of universal health care, but I wish in practice it weren't so difficult to navigate.
Rant over. Feeling marginally better. But my credit card is still burning.
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