FFS (Fee for Service) vs OON (Out of Network)

Learn the difference between fee for service (FFS) and out of network (OON) dental practices.
FFS (Fee for Service) vs OON (Out of Network)
Photo by Vlad Deep / Unsplash

As more insurance companies are lowering their fee schedules, more practices are slowly dropping insurance plans, relieving themselves of the horrendous and diminishing insurance fee schedules. Many dentists will throw the term "FFS" or "OON" around loosely, especially on social media, but there are some slight differences.

Both scenarios are similar: you set your fees and the patient pays your full fee. There aren't any insurance write offs or adjustments due to insurance contract participation, so you get paid the full value for your expertise, time, and work.

A true FFS ("fee for service") office charges full fees, but does not deal with insurance at all. They don't file or send claims on behalf of the patient, don't look up breakdowns, benefits, frequencies, etc. They simply collect the full fee up front, and if the patient does have insurance, then the patient will have to file the claim themselves for any reimbursement/benefits. This the pinnacle we all strive for.

An OON ("out of network") office is similar, but is more like a "FFS Lite" or more insurance version of FFS. They still charge their full fee and will collect up front if the patient does not have insurance. The difference is when the patient does have insurance. Depending on the insurance they have, the office may do a couple of things:

  • They may still collect the full fee up front with the patient, then file to insurance for the patient. Insurance will pay any benefits directly to the patient via check. This way the office gets the full fee immediately up front, without having to wait for insurance to pay the office.
  • Another option involves the office checking the patient's insurance, determining how much the insurance will pay the office for a given procedure as "out of network", then collect the rest from the patient. The insurance will eventually pay the office directly (instead of the patient) and the patient will typically have a lower "out of pocket" cost since the insurance company will pay the office for part of the cost. Patients typically like this because they pay less upfront, but it requires more work on the office to file the claim and wait for payment. You won't get the full fee immediately up front.

Hope this helps clarify some scenarios when you see the words "FFS" or "OON" thrown around. Both are great places to be since you will eventually be paid your full fees.

The New Grad Starter Kit

The ultimate new grad kit including interview questions, note templates, contract review guides, and more.

Get the Kit
Dental Bootstrap

Great! You’ve successfully signed up.

Welcome back! You've successfully signed in.

You've successfully subscribed to Dental Bootstrap.

Success! Check your email for magic link to sign-in.

Success! Your billing info has been updated.

Your billing was not updated.