Access gap cover confusion!

lpswan82 1 October 2010 5

Greetings all,

I used to go to a dentist in Brisbane, and everytime I would walk away with a ZERO bill to pay thanks to the ‘access gap cover scheme’.

Now I just thought that this was something that ALL dentists were part of until I moved to Canberra and for a $100 consultation I only got $35 back?

After some research I read that the scheme is completely optional, and even if they are part of the scheme, they can opt to not publish this fact on the ‘Australian Health Service Alliance’ website. (

Does anyone know of a Dentist who participates in the ‘Access gap cover scheme’ in Canberra??

Also, why would not all dentists be a part of this scheme? It seems like they get paid the entire amount by the health fund? What are the downsides for the dentists/doctors?

Thanks for your replies!

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5 Responses to Access gap cover confusion!
cross cross 7:41 pm 01 Oct 10

Your average Canberra,doctor,dentist,lawyer,accountant is a greedy arrogant elitist pig more concerned about building there next Mc Mansion,getting a bigger 4WD or buying a winery in the country than they are about providing a service at a fair rate.
And by the way I think mechanics and tradesmen are challenging them for the title.
Apparently if you live and work in Canberra you must be an overpaid public servant or executive that deserves to be charged through the nose.

watto23 watto23 3:48 pm 01 Oct 10

Doctors do the same thing. Tell them you have private health insurance and you get charged more over the amount the insurance pays rather than waiting on the waiting list, which generally will cost close to nothing.

The system is crap. I made the mistake once of acknowlodging my private health insurance and I was whisked through surgery and still left with a hefty bill before realising what had happened. And while doing the right thing for the community I still got charged. Next time I’m onto the waiting list.

ConanOfCooma ConanOfCooma 2:28 pm 01 Oct 10

I believe it’s the time frame for returns of the cash.

The docs may do the work, but it takes MONTHS for them to be paid by the fund, not to mention the paper work and effort involved.

peder peder 12:14 pm 01 Oct 10

Most of the insurers have their own ‘gap elimination/reduction’ scheme. The insurer and the dentist have a contract in place whereby the insurer pays an agreed amount for each treatment. This can cover all or some of the treatment cost and it can also depend on your policy. The AHSA represent a number of small insurers and the ‘Access gap cover’ is the equivalent for these small insurers.

Your dentist is not part of the scheme and so your insurer only rebates you the minimum amount they have to as per your policy.

Your question as to why not all dentists would want to be part of this scheme… there are two main possibilities. 1. The scheme has not offered the dentist a contract. or 2. The amount payable to the dentist under the scheme is not attractive to the dentist. Generally the amount payable to providers under such schemes is less than they can earn by charging their preferred private rate.

What tends to happen is dentists (and other healthcare providers) might take part in such schemes with some insurers to guarntee them enough flow through the door, and charge everybody else who is not with the scheme the fee that they feel fit. If all their business was through such schemes they would probably not earn what they feel they are worth. Put simply the contract under this scheme will pay the dentist somewhere between the $35 you got rebated and the $100 consultation fee you got charged. It would be fairly unlikely to be higher than this. Why take part in such a scheme if you have enough people coming through the door paying $100?

As people have mentioned with GP access, there are real healthcare worker shortages in Canberra compared to other capital cities (such as Brisbane), and so supply and demand and all that means that services cost more here.

Using the search facility on the website I have found one dentist participating in the scheme

You also have another option. You could transfer to another health fund that does contract with your dentist and has some kind of gap elimination scheme agreement. If you find a policy with another health fund that offers the same or a ghigher level of cover you can switch without having to go through the usual 12 month waiting period. During the first 12 months you would enjoy the benefits of your old policy, so long as all such cover is provided on your new policy. After 12 months you would have any additional benefits that your new policy covers.

If you like the dentist you are with you could ask them if they participate in any similar gap elimination schemes with any other insurer. If you do switch talk to your new insurer about what you need to do to ensure continuity of cover, such as an exit statement from your old insurer.

taninaus taninaus 10:07 am 01 Oct 10

The health funds probably put a limit on how much the dentist can charge for each procedure. In my experience ACT dentists charge well above the ‘scheduled fee’ and I always have a gap – as such they wouldn’t want to participate in a scheme that gives them a lower return. Only $35 isn’t too bad. good luck finding one in the ACT – there is a shortage with many having long waits so those that participate are probably very popular.

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