Billing Rules for Every Plan Type
In a small dental office, two patients may carry cards from the same insurance carrier but have different billing rules. For example, a PPO reimburses based on contracted fee schedules, so the difference from the office fee is written off. A DHMO, on the other hand, works differently, generally paying monthly capitation per member while patients pay set copays.
The payment process changes further with indemnity plans, which reimburse eligible charges based on plan terms and fee limits. Dental discount plans are different because they are memberships, not insurance, so no insurance claim is filed. Since each plan affects reimbursement and patient responsibility differently, our dental insurance verification services confirm plan type and network status before treatment, helping practices prepare accurate estimates and follow applicable balance billing rules.







