What is a Health Fund Preferred Provider?

Some private health funds have established "Preferred Provider" or "Members Choice" programs. The true meaning of these terms is commonly misconstrued. Being part of a "Preferred Provider" or “Members Choice” program has no relationship to the quality of the care you will receive. In fact, it could actually mean the opposite.

Who can be a Preferred Provider?

Practices nominate themselves to become a "Preferred Provider" or “Members Choice” and sign a non-negotiable agreement that they will reduce their fees and the insurer will then in turn pay a higher rebate per transaction for members. There is no ‘selection’ of a practice based on quality of care, and possibly even promotes reduced quality of care models with shorter consultations compensating the reduced fees. Health funds pay a flat fee to all physiotherapists, whether they have 1 or 50 years experience.

What is the Australian Physiotherapy Association (APA) position?

The APA is concerned that contractual arrangements between Australian physiotherapy clinics and private health insurers create an imbalance of power. The APA submits that:

• the current competition laws do not serve the interests of consumers of privately insured ancillary health services as preferred provider schemes discourage competition and restrict consumer choice of health services;
• Section 46 of the Competition and Consumer Act 2010 (CCA) prohibits a corporation with a substantial degree of power in a market from taking advantage of that power for one or more prohibited anti-competitive purposes. The APA submits that preferred provider schemes encourage a misuse of market power, as demonstrated by BUPA’s market saturation in South Australia;
• existing unfair and unconscionable conduct provisions of the CCA should be strengthened to provide a more efficient and equitable basis upon which the forces of competition can operate; and
• the experience of small businesses is that most small physiotherapy practices are reluctant to engage the Australian Competition and Consumer Commission (ACCC) for fear of damaging their relationship with private health funds.

What have our Experienced Physiotherapists Chosen?

Our team do not believe that they could offer you and your family their current high level of service if they were bound by some of the terms and conditions within the "Preferred Provider" or "Members Choice" agreements. We offer longer appointments than our competitors and hence attract a larger consultation fee. You are receiving quality, comprehensive care.

How Many Consultations Can You Have?

The total gap limit is the same whether you see a preferred provider or not. You may reach your annual limit earlier with higher rebates paid in a preferred provider practice. This is especially the case if frequent, short consultations are not effective or efficiently assisting your needs.

Who Would You Choose to Care for You or Your Family?

At Active Physiotherapy Mackay we do not compromise on quality of care. We hope this information has assisted your decision making process and to better understand why we are not involved in private health fund preferred provider schemes.