We occasionally get asked whether we are a ‘Preferred Provider’ of the various health funds. We have chosen not to participate in these programs because we don’t agree that they enable health fund members to get the best level of care.You will still receive a health fund rebate when you visit Stafford Physiotherapy and Pilates; it may just be a lesser amount than if you were to visit a ‘Preferred Provider’.
This position is supported by the Australian Physiotherapy Association. You can read more on that at the bottom of this article.
Firstly, it’s important to understand what a‘Preferred Provider’ or ‘Members’Choice’ provider actually is…
Some private health funds have established ‘Preferred Provider’ or ‘Members’ Choice’ programs, however the true meaning of these terms is commonly misconstrued.A practice or provider can simply nominate themselves to join these programs with the health funds. In most situations they just have to agree to some non-negotiable terms including significantly reducing their fees; there is no screening process that assesses providers based on experience, qualifications or quality of care. The terms ‘Preferred Provider’ and ‘Members’ Choice’ may imply that you’ll receive a higher standard of treatment, however this is not the case and, in fact, it could actually be the opposite! Some physiotherapists provide shorter consultations in order to be able to offer the fees stipulated by the health fund, however shorter consultations may not be effective at efficiently assisting and addressing your needs.
“But I get a larger rebate when I visit a Preferred Provider!”
This is correct; oftentimes a health fund will pay a larger rebate when you visit a Preferred Provider, BUT keep in mind that your total benefit amount is the same regardless. This means that you may use up your annual limit more quickly and potentially before you have had enough treatment.
Why choose us to care for you and your family?
We understand that people have budgets and visiting a ‘Preferred Supplier’ for treatment is certainly better than not getting treatment for your pain or injury! You may receive a lesser rebate from your health fund when you visit us, however we offer experienced physiotherapists who regularly do further study and continuing education. With us, you are receiving quality, comprehensive care and this is something that we will not compromise on. We have committed to a high standard and have experienced physiotherapists treating our patients and mentoring our younger physiotherapists when needed.
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 is of the opinion 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.
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’ or ‘Members’ Choice’ schemes.