Frequently Asked Questions


What is Fee For Service?  
Fee for service is a straightforward approach to billing where patients pay directly for services received, rather than navigating through insurance write-offs and reimbursements.  Patients pay for services rendered, the office files the claim as a courtesy and the patients get reimbursed by their insurance plan directly. This model allows dental practices to collect their full office fees upfront without waiting to be reimbursed. It’s a clear, transparent way to operate, giving both dentists and patients more autonomy and control over their dental health.

What is the difference between Out of Network and Fee For Service? 

As a general note, FFS means you are OON but OON does not mean you are FFS. The main difference is in Assignment of Benefits (AOB). OON usually means that you have AOB meaning the insurance check comes directly to the office and you only collect the estimated copay from the patient at time of service. OON offices have to verify insurance coverage, calculate breakdowns, and wait for insurance to reimburse them just like in-network offices.

FFS offices however do not have AOB. They still file the patient's insurance as a courtesy but collect their full office fee at time of treatment and the patient gets reimbursed directly from their insurance. FFS offices do not have to verify insurance coverage, calculate breakdowns, or wait for insurance to pay them.

What are the benefits of transitioning to OON or FFS?
You eliminate the middleman, which is insurance, that decides when you can do treatment and how much you can charge. You have shifted the burden on the patient, rightfully so, as it is their coverage and they are responsible for it while getting paid your full office fee. 

Furthermore, if you are FFS, you now get paid immediately for your services without waiting for reimbursement. There is less overhead as there is no need to have staff verify insurance, calculate coverage, and follow up on unpaid claims. There is also increased transperancy for patients as you are no longer "estimating" their copay but are quoting them a set fee. All these factors lead to price control over your fees, increased collections and increased financial stability of your office.

What are the disadvantages of In-Network?
Being in-network, you allow the insurance company to dictate the fees for each procedure that patients get billed for. This means that the dental office is limited on the amount of money they can ask for each procedure. In order for your office to make a profit, you may need to use cheaper materials or labs, rush treatment time for each procedure, do more procedures and see more patients to make ends meet. This in addition to all the insurance hassles to deal with including denied insurance claims, alternate benefits, unpaid claims, sending bills for outstanding balances, etc.

What are the benefits of having a membership plan?
By having an in office membership plan, you offer an alternative to dental insurance that you control and can be offered to increase patient retention when transitioning from in-network. A membership plan can be a recurring monthly or annual payment by the patient to your office in exchange for preventative care and a slight discount off your office fee if you desire. The best part is you control the pricing and the offerings as you see fit. Patients on in-office membership plans will feel valued, more loyal to your office, and grateful for having an alternative option. No more missing tooth clauses, waiting periods, deductibles, or annual maximums!

Will I lose my insurance based patients?
Yes, you will lose some insurance patients. Some patients may have an issue with paying for services upfront and they may not be the best fit for your office. These are usually the insurance minded patients who are just looking for the cheapest price which are not your target market. They will leave and some will come back if you provide the quality is not present in other offices. It is important when transitioning that patients understand that you will still file their insurance and they will be still be reimbursed by their insurance. This is where proper scripting is necessary as most patients do not understand how dental insurance works.