Short answer: your final out-of-pocket cost is the same either way. What changes is how much you hand over on the day and how long you wait to get money back. With an on-the-spot HICAPS claim you pay only the gap and walk out. Paying first and claiming later means covering the full fee yourself for three to six weeks.
This guide walks through both pathways using the actual fees at Richmond Smiles Dental, so you can work out what you will pay before you book.
What is HICAPS and how does on-the-spot claiming work?
HICAPS is a claiming terminal that submits your private health insurance claim to your fund in real time, while you are still at the practice. Your rebate is assessed within seconds and you pay only the difference between the fee and the rebate.
Richmond Smiles Dental is a NIB First Choice provider and a CBHS preferred provider, so members of those funds can claim on the spot. You can read more on our health funds page.
The sequence looks like this:
- You arrive with your health fund card.
- Reception checks your cover, remaining annual limit and any waiting periods through HICAPS.
- You have your treatment.
- The claim is submitted to your fund before you leave.
- Your fund pays the practice directly, usually within one to two business days.
- You pay only the gap, by card or cash.
What does “pay now, claim later” involve?
If your fund is not on the HICAPS network, or you would rather handle the claim yourself, you pay the full fee and submit the receipt to your fund afterwards.
- You have your treatment and pay the full fee.
- You receive an itemised receipt showing the item numbers.
- You lodge the claim with your fund, usually through their app or website.
- Your fund assesses it, typically within one to four weeks.
- The rebate is paid into your account.
Most funds allow up to twelve months to lodge a claim, though this varies. Check your own policy.
Worked examples using our actual fees
The rebate figures below are illustrative only, because every policy rebates differently. The treatment fees are our current published starting prices.
A dental filling
Our fillings start from $150. If your fund rebates $90:
- On the spot: you pay $60 and leave.
- Claim later: you pay $150, then wait three to six weeks to recover $90.
A dental crown
Our crowns start from $1,500. If your fund rebates $600:
- On the spot: you pay $900 and leave.
- Claim later: you pay $1,500 and wait weeks to recover $600.
On larger treatments the difference in cash flow is what matters. Both pathways end at $900 out of pocket, but one asks you to find $1,500 on the day.
A check-up and clean
Our check-up and clean is $289 and includes the exam, clean, polish, fluoride and X-rays. Many extras policies cover a large share of preventive care, so the gap is often small — and with HICAPS you find that out before you pay.
Children covered by the Child Dental Benefits Schedule
For eligible children we bulk-bill under the Child Dental Benefits Schedule, so there is nothing to pay on the day. See our kids dental page for what is included.
The scheme is capped at $1,158 per child across two consecutive calendar years, and the cap is indexed each January. It covers examinations, cleans, fluoride, X-rays, fillings, root canals and extractions. It does not cover orthodontic or cosmetic treatment. Current details are published by Services Australia.
Comparing the two pathways
| Factor | On-the-spot HICAPS | Pay now, claim later |
|---|---|---|
| Amount you pay on the day | The gap only | The full fee |
| Waiting for money back | None | Usually 3–6 weeks |
| Paperwork | Handled by the practice | You lodge the claim |
| Knowing your rebate in advance | Confirmed before you pay | Unknown until assessed |
| Annual limit check | Checked in real time | You may discover a shortfall later |
| Works with every fund | Only funds on the HICAPS network | Yes |
| Deciding later whether to claim | No, decided at the appointment | Yes, within your fund’s deadline |
When paying later makes more sense
On-the-spot claiming suits most people, but paying first is the better fit when:
- Your fund is not on the HICAPS network.
- You hold separate gap cover and want to lodge with both insurers in a particular order.
- You want to decide later which benefit year to claim against.
If your fund reduces or rejects a claim
The most common reasons are an unmet waiting period, a service not included in your level of cover, an exhausted annual limit, or a missing pre-approval. With on-the-spot claiming these surface before you pay. With pay-later claiming you find out after the money has already left your account.
Spreading the cost
If the gap is difficult to cover in one payment, we offer flexible payment plans, subject to eligibility and approval. Ask our team when you book. A payment plan is separate from claiming — your rebate is still processed the same way.
Our guide to making the most of your dental extras covers timing appointments around annual limits and benefit years.
How to claim on the spot at Richmond Smiles
- Bring your health fund card to your appointment.
- Tell reception you would like to claim on the spot.
- Ask for your rebate amount before treatment begins, so you know the gap.
- Pay the gap at reception before you leave.
Common questions
Does my final out-of-pocket cost change depending on the method?
No. Once the rebate is paid, both pathways leave you with the same net cost. The difference is the amount you outlay on the day and how long you wait.
What if I forget my health fund card?
You can still be treated. We may be able to look up your membership, or you can pay the full fee and claim later.
How do I know if my annual limit is nearly used up?
HICAPS shows your remaining limit at the time of the appointment, so we can talk through whether to proceed now or wait until your benefits reset.
How long until the rebate reaches the practice?
Usually one to two business days. This does not affect you, because you have already paid only the gap.
Book an appointment
Tell us your fund name when you book and we will confirm your cover and expected gap before you come in. Call (03) 9428 6587 or book online. We are at 1/84 Church Street, Richmond VIC 3121, open Monday to Friday, 9:00am–5:00pm.
Reviewed by Dr John Kendler, General Dentist and Principal Dentist at Richmond Smiles Dental. Fees shown are our current starting prices and may change; your treatment plan will set out exact costs before you proceed. Rebate amounts depend entirely on your own policy. This article is general information and is not financial advice.
