Dental Point of Service (POS) Plans: A Billing Guide for Dental Practices

April 9, 2019

Updated 03/2026

People can choose from a variety of health and dental insurance plans. Some of these plans include HMO and PPO plans. Both of these plans have their caveats and benefits. For instance, people in HMOs pay cheaper premiums but must remain in-network. Meanwhile, people in PPOs pay higher premiums but can visit their preferred doctors, even when out-of-network. Alternatively, people can enroll in Point of Service (POS) plans.

How POS Plans Work

POS plans have their own caveats, but they can also benefit people. These policies contain terms and conditions similar to those in HMOs and PPOs. For instance, beneficiaries in both POS and HMO health insurance policies usually need to visit a primary care physician (PCP), who would refer them to any specialists in their policies’ network. In some POS policies, beneficiaries usually do not have to pay a deductible for procedures performed by a PCP, and preventive care benefits are usually included.

Unlike an HMO health plan, POS health plans allow beneficiaries to visit out-of-network providers for less coverage. People must still pay co-payments, coinsurance, and an annual deductible. People may be responsible for high deductibles when visiting out-of-network providers, so patients who use out-of-network services will pay the full cost of care out of pocket until they reach the plan’s deductible. Fortunately, when a PCP refers the patient to an out-of-network specialist, the POS plan will pay more toward an out-of-network service. Also, beneficiaries can take advantage of the plan’s nationwide coverage to receive benefits for visiting physicians in other places.

Premiums for POS plans are usually lower than premiums for PPOs, but they are usually higher than premiums for HMOs. Like POS health plans, POS dental plans also allow beneficiaries to visit out-of-network dental providers. When people visit those providers, they are still responsible for their deductible, co-insurance, usual and customary fees, and benefit limitations. POS dental plans can reimburse their beneficiaries based on a low table of allowances; with significantly reduced benefits than if the patient had selected an in-network provider.

POS vs PPO vs HMO: Key Differences for Dental Billing Teams

How POS Plans Affect Reimbursement for Your Practice

POS dental plans typically reimburse out-of-network services based on a table of allowances rather than usual and customary fees. This means the plan pays a fixed, predetermined amount for each procedure regardless of what your practice charges. The difference between your fee and the table of allowance amount is often the patient’s responsibility — which means practices that do not verify POS benefits before treatment regularly face unexpected patient balance disputes and reduced collections

POS plans represent another option for people who want certain benefits from their insurance. Although they cost more than HMO plans, they can benefit those who want to visit out-of-network providers and pay less than PPO plans.

If you are struggling with insurance plans, whether HMO, PPO, or POS, consider partnering with eAssist. Our Success Consultants are familiar with various types of coverage and will ensure your claims are billed correctly. To learn more schedule a consultation.