What Is A Point Of Service Plan? - Capline Dental Services

What Is A Point Of Service Plan?

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A point of service plan is a managed care health insurance plan, which can be best understood as an amalgamation  of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO).  

“Point of Service” in POS plan refers to the type of dental services (in-network or out of network) the patient opts  for. Point of Service plans offer coverage for both in-network as well as out of network service, but the coverage  amount varies depending upon both. The cost of dental service is lower in an in-network service when compared  to out of network services. 

How does the Point of Service Plan Works? 

Similar to HMO, a point of service plan requires patients to choose an in-network dentist. Furthermore, in the POS  plan, a referral is required by the in-network dentists if a patient chooses to visit a dental specialist. In such  scenarios, according to policy agreement, dental professionals are bound to charge the pre-decided amount for  the rendered service as they have agreed to accept the payer’s reasonable and customary amounts as payment in  full. The out of pocket cost in such scenarios is minimal for patients. 

Similar to the PPO, the point of service plan also offers coverage for out of network dental professionals.  Therefore, if the patient visits an out of network dentist or specialist without the referral, the POS plan will still  provide dental coverage for the same; however, the coverage amount will be less and out of pocket amount will be  higher in such scenarios. Furthermore, the out of pocket amount could be lesser if the patients have a referral  while visiting an out of network dental specialist. The amount reimbursed in out of network medical service is  usually based on a reasonable and customary amount. However, in such scenarios, the dental professional has the  authority to charge for the rendered services as much as they deem fit. It is then the responsibility of the patient to  settle the additional amount, which is not covered by the POS plan. (The additional amount is not part of  deductibles, co-payments, or co-insurance). In addition to that, it is also the responsibility of the patient to file the  insurance claim when they visit an out of network medical professional. 

Benefit of POS Plan: 

  1. POS plan offers coverage for out of network dental services, which not only allows patients to seek  dental assistance from their preferred dental professionals, but also enables dentists to charge appropriate  fees for the rendered services. 
  2. POS plans are beneficial in rural and suburban locations where in-network dental professionals are scarce.
  3. In POS plans, co-pays are quite low and affordable even to low-income groups. Additionally, most of the  POS plans have zero deductibles. 

Disadvantages of POS Plan: 

  1. POS insurance coverage flexibility for in-network and out of network dental professionals is its biggest  perk but only to those patients who often require out of network dental assistance. POS plans can be  costlier than PPO plans and would not benefit patients who rarely seek out of network dental treatment. 
  2. Most POS plans require a referral to visit a specialist to provide promised dental coverage. However, in  PPO plans, a patient can seek dental assistance from an in-network specialist without any referral. 
  3. POS plans may require patients to pay the dental fees upfront, which is reimbursed by the payer within a few months. However, this payment structure can be financially burdening for patients who belong to  low-income groups. 

The rules and regulations, along with offered benefits in the point of service dental plan, vary in each  insurance company. The above explained is the generalized version of what most of the insurance companies offer.