If you are considering dental and oral surgery, you should request an estimate from your general dentist or oral surgery specialist to see what health fund benefits you are eligible for and what you will have to pay out of pocket.
In 2010, an Australian Institute of Health and Welfare (AIHW) survey found that 28 per cent of people five years of age or older did not visit the dentist due to cost. The cost of visiting the dentist will vary depending on your health insurance policy, so it is important to understand what you are entitled to in order to get the best policy.
The 2010 National Dental Telephone Interview Survey by AIHW found 53.8 per cent of Australians who were aged five and older had dental insurance of some kind. However, in 2011-12 individuals paid for 56.8 per cent of total dental costs out of their own pocket.
Visiting the dentist is an important part of caring for your overall health, and 2 in 3 Australians over the age of five have visited a dental practitioner in 2013, according to the AIHW. However, this number increased for people with dental insurance (72 per cent) and decreased for those without insurance (50 per cent).
Reasons given for going to see a dentist differed between age groups. Individuals between the age of 15 and 24 were more likely to go for a check up (80 per cent), whereas those between 45 and 64 were more likely to attend due to a problem (47 percent).
What dental cover could mean for you
Wisdom tooth extraction is one of the most common oral surgery claims made to insurers under private health insurance policies. What your policy covers changes based on who performs the procedure, for example a dentist or an oral surgery specialist, or if you are an in- or out-patient.
The Private Health Insurance Ombudsman (PHIO) explains the level of policy you have will determine the health fund benefits you receive if you have cover for tooth extraction and have been on the waiting list for approximately 12 months.
If you have a hospital and general treatment policy then you will be covered for hospital accommodation and theatre fees, anaesthetist fees and other medical fees and dental fees from a general dentist and oral surgery specialist. However, if you only have a hospital policy or a general treatment policy then you will not be covered for all of these benefits.
Get a quote
The PHIO recommends that you get a quote from your general dentist or the specialist in writing that outlines their fees and services. Important things for the quote to include are:
- Dental item numbers
- Name and number of the provider (oral surgery specialist or dentist)
- The estimated cost of the procedure
Run the quote past your insurance provider to find out the difference between the quote and the amount covered by the health fund. Any excess will be at your own expense.
The 2010 survey found that around one-quarter of people aged between 25-64 did not have the recommended treatment due to cost. Make sure when you are comparing health insurance policies you choose the best one for you and your family.
Policies differ on terms, for example some health funds may consider a surgical tooth extraction as a general dental treatment. However, surgical tooth extraction is usually considered to be a 'Major Dental' treatment, and you will need to have a different level of cover for it be provided for in your policy.