Fees & payment
Preferred provider health funds
Dr Justin Lee has personally signed on as a preferred provider with seven major health funds, which generally means a smaller gap for members. Every other fund is still claimed on the spot.
Preferred provider for
- AHM
- CBHS
- Defence Health
- HBF
- HCF
- Medibank
- NIB
Not on the list? You are still very welcome. Every Australian health fund is claimed on the spot through HICAPS, so you pay the gap on the day rather than claiming back yourself.
Preferred provider status belongs to the dentist, not the practice
This trips people up regularly. A practice can appear on a fund's list while an individual dentist working there has not signed on, because each dentist agrees to these arrangements individually and not everyone chooses to.
So checking that a clinic is in your network is not quite the same as checking that the dentist you are actually seeing is. If you want the preferred provider rate with one of the funds above, book specifically with Dr Justin Lee and say so when you call.
How the arrangement works
It is a straightforward trade, and understanding it makes the numbers on your receipt considerably less mysterious.
Agreed fees
I have agreed to charge the fund's set fees for certain treatments, so the amount being claimed against is capped rather than open-ended.
A higher benefit
In return, the fund pays its members a larger portion of that bill than it would at a practice outside the network.
A smaller gap
Both sides of the sum move the same way, which is why the out-of-pocket amount is usually lower. How much lower depends on your specific policy.
Your fund may call it something else
Funds brand these networks under their own names, which makes it harder than it needs to be to work out whether your dentist is in one. Members' Choice, participating provider and First Choice all describe the same basic arrangement.
If the wording on your fund's website does not match anything here, ring them and ask directly whether Dr Justin Lee is in their network at Pacific Smiles Dental Belconnen. That question gets a clear answer.
Worth knowing before you book
- Rebate percentages are calculated against your fund's schedule fee, not the actual treatment cost
- Annual limits still apply, and higher rebates can mean reaching them sooner
- Waiting periods apply to new policies, commonly two months for general and twelve for major dental
- No-gap arrangements depend on your level of cover and specific item numbers
No health insurance? There may be another route
Private cover is not the only way dental care gets funded. Children may be eligible for free treatment under the CDBS, veterans are billed directly to DVA, and eligible adults may be offered an ACT Health voucher.
Frequently asked questions
Preferred provider arrangements, rebates and annual limits are set by the health funds and can change. Please confirm your own cover directly with your fund.
Book with Dr Justin Lee
Bring your fund card and we will claim on the spot. If you want to know your gap before committing, ask for a quote with item numbers and check it with your fund first.