Fee-for-service

Fee-for-service describes a practice charging its own full fee for a procedure, with no contractual discount negotiated with an insurance company. A patient with fee-for-service dental insurance, or a patient with no insurance at all, pays what the practice actually charges: the same number a PPO patient's plan compares its allowed amount against when calculating that plan's discount.

This is the baseline every insurance conversation in the practice measures itself against. Write-off percentage, profit per hour, and the whole case for dropping or keeping a given PPO all start from the gap between the plan's allowed amount and the fee-for-service rate for the same procedure. A practice that has never clearly calculated its own fee-for-service rate for its ten or twenty most common codes is missing the one number every other insurance decision depends on.

Moving toward more fee-for-service and out-of-network patients, rather than eliminating insurance outright, is the direction most of Ryan's PPO strategy points, not as an ideology, but because the profit-per-hour math on fee-for-service work is almost always meaningfully better once overhead is accounted for.