So the first question is which state are you in? There are some states that allow you to use both but you would bill to the insurance company the discounted rate. The patient would pay the lowest Fee schedule. IF they sign an exempt form- the work that is done can NEVER be shared with anyone else. So all work regarding that/those teeth cannot leave the office or be given out with their history. This is a very difficult thing to track and could lead to a potential HIPAA breach at some point in the future. Also that patient can retract that release at any time and you would then be billing the insurance and could end up owing that patient money back.