Preferred Provider Schemes: What are they?

We often get asked why we aren’t part of any preferred provider schemes, and so we have put some information together to help you understand how these schemes work, and why we do not participate in them.

It also outlines some options that may be of benefit for you to consider.

Firstly it is important to point out that when seeing a practitioner at Move, you will be able to use your private health insurance (PHI) towards the fee if you have appropriate cover (usually called ‘Extras’). However, Move is not currently a member of any preferred provider schemes.

We believe that schemes such as these do not allow us to sustainably offer the expert services, longer appointment times, highly experienced staff and the physical environment that we do.  We feel that compromising in any of these areas would not fit with the values we have set for our practice for over 20 years.

What is a preferred provider scheme?

Some PHI companies have created their own list of health providers which they recommend to their members.  These providers are generally marketed as being ‘preferred’ as though they have achieved this title through clinical excellence but in fact these are just practices who have agreed to sign a contract which allows the PHI to set the fee structure and reimbursements for the practice.

There are no minimum standards of practice, experience or quality of care required to qualify for these contracts.  It is purely an agreement that the practice will charge those patients the amount the insurance company has set.

You might ask why a practice would do this.

It is an easy way to gain exposure to many prospective new patients, so it can be an effective way to get your practice up and running if you are just starting out or perhaps if your practice is not doing too well.  Many of the practitioners we have spoken to who have been part of these schemes at other practices only ever thought they would do this temporarily, but now feel stuck in their contracts.

So what’s wrong with that?

Although discounting services to get more patients to your business might be good to start with, and also good for the patients who will have a smaller gap to pay, problems occur relatively quickly when there are many patients coming to the clinic who are not paying a normal/typical fee.  The cost of providing adequate length appointments with experienced staff generally is too great for the business to sustain.

Practices in these schemes may then be forced to make some difficult decisions about how they run their business, and generally these result in shorter appointment times or using less experienced staff who they can pay less (or both).  The combination of these two things is a big concern to the allied health industry as it is likely to be detrimental to the quality of healthcare provided to the patient.

Why are they allowed to do this?

There are many complaints made to the ACCC against PHI’s regarding these policies, however we are yet to really see any significant change to their behaviour, which has been reported as uncompetitive, unfair, bullying and ultimately potentially detrimental to the patient’s healthcare.

What can you do?

Remember that you have a choice!

If you are concerned about the small contribution your health fund makes for physiotherapy or other allied health, it is important you know that you can shop around for an insurer that better suits your needs.  Some funds (usually the smaller not for profits) pay much better rebates for allied health.  It is important to note also, that you can have hospital cover with one insurer, and your extras cover with another.

What does the Australian Physiotherapy Association say about preferred provider schemes?

This information is taken directly from their website:

“The Australian Physiotherapy Association remains concerned that health funds actively divert their members to network providers, regardless of existing therapeutic relationships.

The APA believes the term ‘preferred’ might make a patient think a practice is of a particular standard than those practices that are not preferred. This is not the case. By being a preferred provider, a physiotherapist simply elects to join the scheme and bring their fees in line with what the health funds mandate. We know this is a significant disadvantage to physiotherapists and that keeping fees close to market rates is essential to maintain the financial viability of a physiotherapy business.

We have raised this matter with the ACCC, which has not determined this is a matter for further investigation. We will continue to advocate for change when appropriate.”

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