Billing · Updated 2026-09-08 · 5 min read
What does 'Delta Dental PPO Point of Service' mean?
Point of Service is an employer add-on to a Delta Dental PPO plan that pays Premier pricing when the patient sees a Premier dentist who is not in the PPO network.
"Delta Dental PPO Point of Service" is a Delta Dental PPO plan with an out-of-network option added to it by the employer. When the patient sees a Delta Dental Premier dentist who does not participate in the PPO network, and that dentist's fee is higher than the PPO schedule fee, the plan pays at Premier pricing levels rather than PPO. For a Premier-only office, that is the difference between being paid off the PPO schedule and being paid off the Premier maximum plan allowance on the same patient. It is the exact opposite of a Delta Dental PPO MAC plan, which pays the PPO fee to every tier. Kaylie has not measured how many Delta plans carry the Point of Service option; the carrier's stated policy is below.
What Delta Dental's own documents say
The definition comes from a provider manual written for dentists, not from a member brochure:
"Many employer groups have an out-of-network option under Delta Dental PPO called Delta Dental PPO Point of Service. When a member utilizes the services of a Delta Dental Premier dentist who does not participate in the Delta Dental PPO Program and that dentist's fee exceeds the PPO schedule fee, benefits will be paid according to the Delta Dental Premier pricing levels."
— Delta Dental of New Jersey 2023 Participating Dentist Handbook, Chapter 15.
The same handbook says who buys it and why:
"This is for employer groups who have sought the flexibility to increase the allowable benefits for services rendered to subscribers who have chosen not to seek the services of a Delta Dental PPO dentist."
— Delta Dental of New Jersey 2023 Participating Dentist Handbook, Chapter 15.
Two things follow from those two paragraphs. First, Point of Service is not a network. Nobody credentials into it and no office joins it. It is a benefit option attached to a PPO plan, and the only party that decides whether a plan has it is the employer. Second, it is a payment rule that only fires in one situation: a Premier dentist who is not in PPO, treating a PPO plan's member, at a fee above the PPO schedule.
For contrast, the same carrier family's PPO MAC plans run the rule backwards. Under a MAC PPO plan, payment for a Premier dentist and for a non-participating dentist alike "is based on the PPO dentist's allowable fee", and members "are responsible for the difference between the Premier Maximum Reimbursable Amount (MRA) and the PPO fee" — Delta Dental of Arizona Flex Choice Group Plan Benefit Highlight Sheet, 2025. Point of Service raises the allowance toward Premier; MAC lowers it to PPO. Both are printed as network lines on plan documents, and both are decisions the employer made when it bought the plan.
Why it depends on the plan
Point of Service is a plan attribute, so it is invisible in anything that describes your office. Your participation status tells you which contracts you signed; it does not tell you which allowance this employer's plan will apply to a claim from you.
That matters most for a Premier-only office. On an ordinary Delta Dental PPO plan, a Premier-but-not-PPO dentist may be reimbursed at Premier fees or at PPO fees, and Delta puts that squarely to the employer: "How Premier dentists are reimbursed under your PPO plan is up to you" — Delta Dental, "PPO and Premier: How Delta Dental's dual network works", Word of Mouth, October 14 2022. Point of Service is one of the shapes that choice takes. A plan with it pays your Premier allowance. A MAC plan pays the PPO fee and leaves the patient owing the difference up to the Premier allowance. Two patients, two employers, identical cards, two different numbers on your remittance.
Nothing an office can read in advance settles it, and a Delta member company says so to its own dentists. The letter confirming your filed fees will
"NOT indicate if a particular fee exceeds the Premier level of fees. You will know this only after a claim reporting the procedure has been processed or submission for a Pre-Treatment estimate."
— Delta Dental of New Jersey 2023 Participating Dentist Handbook, Chapter 2. The ID card and the carrier's provider website both name the plan's network. Neither names the allowance basis the plan will apply to a dentist in your position, which is the number your estimate needs — so on a Premier-only office's Delta patients, the pre-treatment estimate is the instrument, not the card.
In practice the same product is written several ways on plan documents and eligibility responses. Delta prints "Delta Dental PPO™ Point of Service" as the network line on summary-of-benefits documents, and the same product also appears as "Delta Dental PPO - Point of Service" and "Delta Dental PPO (Point-of-Service)". Those are three spellings of one product, and none of them is plain "Delta Dental PPO", even though a card carrying any of them is a PPO card.
What to do
- Read the network line on the plan, not just the carrier name. "Delta Dental PPO Point of Service" is a different product from "Delta Dental PPO" and from "Delta Dental PPO with Maximum Allowable Charge", and the three pay a Premier office differently.
- If you are Premier and not PPO, this is the question to ask the payer before treatment: under this plan, is a Premier dentist reimbursed at Premier pricing levels or at the PPO schedule fee? Point of Service is one of the answers you may be given.
- Load the Premier allowance as well as the PPO schedule. On a Point of Service plan the Premier allowance is the number the plan will pay from; on a MAC plan the PPO schedule is, and you need both loaded to quote either.
- Quote the patient from the allowance the plan will use, not from the coverage percentage. The percentage applies to the allowance, and on a Point of Service plan the allowance is the higher of the two.
- If you are PPO, this option changes nothing about your own payment. It exists to protect the patient who went to a Premier-only dentist, not to raise a PPO office's fee.
Numbers last refreshed August 2026.