capline dental services

How Does A Fee For Service Plan Work in Dentistry?

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In the fee for service plan, dental practitioners charge their patients for each service provided by them. These service charges are decided by the dental practitioners themselves. They can either ask their patients to settle the complete invoice amount for the rendered services or settle the co-payment amount. If the patient settles the complete invoice amount, the insurance companies are liable to reimburse the amount directly to the patient as per their terms of the policy. On the other hand, if the patient chooses to pay only the co-payment amount, dental practitioners can submit the claim and demand reimbursement from the insurance companies.

FFS plans are beneficial for both dental practitioners as well as patients. Fee for Service plans allow patients to seek dental care from the practitioner of their liking. Quite a lot of patients are not satisfied with the services provided by their PPO dental practitioners and prefer to opt for non-PPO dentists. Furthermore, PPO services are not available in every part of the country, and thus, patients have to seek non-PPO dental practitioners for dental services.

FFS works differently for non-PPO and PPO dental practitioners. Below, we have briefly described the difference between both, along with their pros and cons.

Fee For Service Plan for non-PPO

When a patient chooses to opt for a non-PPO dental practitioner, the dentist has the authority to decide the fee for their services themselves. It is the responsibility of the patient to pay any surplus amount, which is not covered by their dental insurance.

Pros: A dental practitioner can charge a satisfactory amount for the rendered services and it does not have to depend upon the designated service process by the insurance companies.

Cons: Submitting the claim for FFS for non-PPO requires additional paperwork, and the claim reimbursement can be a lengthy process in such scenarios.

Fee For Service Plans for PPO

When a patient chooses to go to a PPO dental practitioner, they are only liable to pay the amount which is not covered under their insurance plan.

Pros: Submitting the claim for FFS for PPO does not require excessive paperwork and the claim reimbursement is much simpler compared to non-PPO FFS.

Cons: A dental practitioner can only charge the designated amount by the insurance companies. Additionally, PPOs do not have a wide presence in each part of the country.

Can a non-PPO dental practitioner file an insurance claim on behalf of their patient?

Yes! A dental practitioner, if willing, can file the dental insurance claim on behalf of their patients. 

As patients are not well versed with the insurance claim processes, in most cases, the patient settles the bill amount charged by the dental practitioner and seeks guidance for claim procedure by their dentists. After the dental practitioner submits the claim, along with the required documents, it can take up to 30 days for the patients to receive the money. If a dental practitioner chooses to file an insurance claim on behalf of their patients, it is their responsibility to educate the patients about the turn around time of the process to keep future hassles at bay.

How to handle both non-PPO and PPO plans along with other insurance plans?

As a dental practitioner, it can become overwhelming to handle multiple types of insurance plans, claiming process, and claim denials, along with patient care. Considering America’s competitive dental industry, a dental practitioner has to be perfect in handling all the mentioned tasks. To overcome all these issues, more and more dental professionals are outsourcing dental billing services. 

Outsourcing these services not only decreases a large amount of stress borne out of insurance billing but also provides required assistance from the experts in efficiently handling all the steps of dental billing. Dental billing companies take care of patients’ appointments, insurance plan handling, documentation work, denial management, patient verification, and so much more.

In today’s medical world, dental and medical billing companies like Capline Services have become a trustworthy alliance in the industry giving access to supporting professionals at each step.