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:
Disadvantages of POS Plan:
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.