Key Takeaways
- Preferred provider networks might actually limit your choices for healthcare.
- Independent health providers can suffer from unfair market practices.
- Going with a Fair Health Care Alliance-approved fund will give you the most freedom of choice and total fairness.
Our Mission at Fair Health Care Alliance
Fairness and transparency are incredibly important issues for both consumers and health practitioners alike. As healthcare costs continue to rise, you probably want to know how health insurance companies operate – and what makes them ‘fair’ – so that you can make smarter decisions about your health and finances.
At Fair Health Care Alliance, our core mission is to promote fairness and transparency above all else. That’s why we put together this guide to explain how preferred provider networks work, as well as to discuss the implications of restrictive agreements between health funds and practitioners.
And to top things off? We share our approved list of health insurance companies that truly embody our values of choice and fairness.
What are preferred provider networks?
Simply put, they are arrangements where health insurance companies partner with a collection of healthcare providers to give their members higher rebates or lower out-of-pocket costs. On the surface, it might seem incredibly useful. After all, there’s the promise of cheaper treatment costs for policyholders. Australia’s largest health insurers like Medibank, Bupa, HCF, HBF, AHM and nib have all widely recognised preferred provider programs.
But there’s a catch – and a hidden cost. These networks seriously limit your options as a consumer. In other words, they push patients towards providers that have been chosen primarily based on financial agreements, not patient preference or the quality of care. Providers outside of these networks, in most cases, simply can’t compete fairly because of artificially lower rebates for their services.
Hidden drawbacks of preferred provider agreements
It’s true that at face value, many people might see preferred provider programs as being a good thing. But the reality is that they have serious implications for healthcare practitioners and patients alike.
Here’s why:
1. Fewer options as a patient
Under these agreements, policyholders are incentivised – or financially coerced – to only visit providers within the network. This means that any patient who wishes to remain with an independent practitioner who is not part of the preferred provider network (maybe a specialist they’ve seen for years) will be slapped with huge out-of-pocket expenses if they decide to keep seeing them.
2. Negative impact on independent healthcare practices
Preferred provider agreements can put independent healthcare providers at a massive disadvantage. How? Independent practices can see substantial declines in their patient numbers simply because they choose not to – or are unable to – participate in these networks. Many small practices end up finding themselves forced into difficult financial situations or even closures as a result.
3. Zero transparency and control
Patients and practitioners alike tend to be unaware about the full extent to which health funds dictate treatment frequencies, fees, rebates and more. Decisions that should remain between patients and healthcare professionals suddenly become influenced – or even determined – by health funds. Shouldn’t this raise serious concerns about transparency and fairness?
Why fairness matters in healthcare
Fairness in healthcare should never be seen as a ‘nice-to-have’. It’s a must. Patients should feel unshackled and be free to pick from the top healthcare providers based on quality, trust and their own personal preference – not financial pressure or incentives.
Moreover, healthcare providers should compete fairly based on patient care and service delivery. Artificially skewed markets where insurers dictate all the terms simply undermines the integrity and sustainability of our healthcare system.
Portability
Don’t re-serve waiting periods when you switch to a new health fund or policy
“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”
Our criteria for choosing the fairest funds
At Fair Health Care Alliance, you can trust that we rigorously evaluate health funds based on their commitment to fairness and choice. Our approved health insurers:
- Give you genuine freedom of choice without burdensome financial penalties.
- Have very small or no preferred provider networks.
- Show total transparency in their rebate structures and policy conditions.
- Actively support independent healthcare practices and equitable access to healthcare around the country.
Fair Health Care Alliance-approved health funds
Here’s the current list of health insurance providers who meet our criteria for fairness and transparency:
- ACA Health Benefits Fund
- Doctors’ Health Fund
- Emergency Services Health
- frank Health Insurance (formerly health.com.au)
- GU Health
- HIF Health Insurance
- Health Partners*
- Hunter Health Insurance
- Latrobe Health Services
- Mildura Health Fund
- Onemedifund
- Navy Health
- Nurses & Midwives Health**
- Peoplecare
- Phoenix Health Fund
- Police Health Insurance
- Queensland Country Health Fund
- RT Health
- see-u (formerly CUA Health)
- St Lukes Health
- Teachers Health**
- Transport Health
- TUH
- UniHealth**
*Health Partners have four branded dental centres in and around Adelaide city.
**Teachers Health Fund, Nurses & Midwives and Unihealth have five health centres total in Surry Hills NSW, Parramatta NSW, Hamilton NSW, Richmond VIC and Adelaide SA.
Supporting fairness and independence in healthcare
When you choose one of our approved insurers, you’re making an important statement. You’re essentially saying that you support:
- Every patient’s freedom to pick the healthcare provider that’s best suited to their needs.
- Independent health practitioners who deliver high-quality care without financial coercion.
- Transparency in all health insurance practices, as well as for consumer protection.
Misconceptions about switching health funds
One final word on fairness in health insurance: waiting periods. It’s quite a common misconception that switching health insurance means you’ll have to re-serve waiting periods. Thankfully, this isn’t true. Under Australian law (i.e. portability), if you switch to an equivalent or lower level of cover, any waiting periods you’ve already served must be honoured by your new fund.
Switching is straightforward, and in many cases you might end up with cheaper premiums and fewer limitations on your cover.
How FHC can help you get more from your cover
We take pride in comparing health insurance policies from a diverse range of our approved funds. Our experienced advisors will give you side-by-side policy comparisons after chatting to you about your specific needs.
They will also spend time making sure your health insurance lines up with your personal preferences around healthcare. And best of all? They’ll handle all the heavy lifting to make the switching process totally seamless – with no disruption to your cover or care.
Support fairness, choice and transparency by comparing health insurance policies with Fair Health Care Alliance today. From our list of approved insurers, you’ll be empowered to choose the healthcare providers you trust, without financial penalty. So take action to protect your health and your right to choose.
FAQ's
They are healthcare practices that have agreed to specific terms set out by health funds to charge lower out-of-pocket costs to the fund’s members.
No, switching health funds is simple and your new fund must legally recognise any waiting periods you’ve already served.
Absolutely! Smaller funds can deliver much better customer satisfaction and more benefits.
