ADA’S SUBMISSION TO THE ACCC TO PREVENT FURTHER ANTI-COMPETITIVE HEALTH FUND PRACTICES
According to the Australian Dental Association (ADA), health insurers currently individually boycott service providers unwilling to accept “take it or leave it” contracts from health insurance companies.
For example, a major health insurer recently wrote to all dentists in Australia indicating that the mere provision of a service to a person who had purchased its insurance product is an acceptance of contractual terms and if it’s terms are not accepted the practice will be ‘de-recognised’ and the particular insurer will not pay any claim by the patient.
According to the ADA’s submission to the ACCC this authorisation would have the effect of significantly impacting many of the individually owned dental practices if a buying group of large health insurers were to pose the same conditions as is currently being applied by this particular health insurer.
Furthermore, the authorisation to include the ability for the provision of services under existing government schemes which are open to both public and private dental services may result in small businesses being completely locked out and service delivery restricted for patients.
The ADA believes that such practices result in incremental changes that over time have a detrimental impact on patient choice.
This extends the reach of insurers in relation to clinical matters and audit powers to seek to claw back from the small business funds properly earned through the provision of a legitimate service to a patient. In other words, a dentist and a patient agree on a course of treatment and then a health insurance company later decides that they have concluded with no genuine right of appeal and without discussion with the patient.
The submission further states that there is already a marked imbalance of market power between health insurers and small community-based health practices. Extending the ability to collectively use (or misuse) this very significant imbalance of market power is unconscionable insists the ADA.
For the full submission please click on the following link:
Dr T. S. Saw OAM
Wheelers Hill Dental