Fee-for-service

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Fee-for-Service

A form of health insurance where the policyholder pays for medical expenses out-of-pocket and receives a reimbursement from the insurer. That is, a fee-for-service plan reduces the insurer's risk that the plan might be abused by requiring the policyholder to pay for expenses first, and only reimburses him/her afterward. Generally speaking, a fee-for-service policy includes some co-insurance. Some medical practices require fee-for-service payment to reduce the risk that it cannot perform a procedure if the insurer denies coverage. That is, the practice expects the patient to pay when the service is given and to file with the insurer for reimbursement afterward.

Fee-for-service.

When you're covered by fee-for-service health insurance, you pay your medical bills and file a claim for reimbursement from your insurance company.

Most fee-for-service plans pay a percentage -- often 70% to 80% -- of the amount they allow for each office visit or medical treatment. You pay the balance of the approved charge plus any amount that exceeds the approved charge.

Your share of the approved charge is called coinsurance.

If you are enrolled in Original Medicare, which is a fee-for-service plan, your healthcare provider will file the insurance claim on your behalf.

References in periodicals archive ?
Reports of aggressive marketing, confusion by seniors and physicians refusing to see patients enrolled in private fee-for-service plans gave the product"a black eye," said Calabrese.
All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.
Some HMOs scored poorly (but) enrollees rated many HMOs higher than traditional fee-for-service plans in several health care markets,'' said Dennis Becker, a Medstat vice president.
One of the largest insurers in the program, the Government Employees Health Association, offers a fee-for-service plan for single individuals at a cost of $2,548 a year ($212 per month), including both the employee's and the government's share.
The study found that elderly people and poor people who are chronically ill "were more than twice as likely to decline in health in an HMO" than in a fee-for-service plan.
As a result, the share of health care participants covered by fee-for-service plans has declined.
Thus it is important to understand how service use differs between prepaid and fee-for-service plans, especially for the sickest patients, who have the greatest need for care.
Another management issue for physician groups is comparing the profitability of HMO plans to not only each other, but also to other types of plans, including fee-for-service plans.
All fee-for-service plans enjoyed the same proportion of medically appropriate service use (judged by two physicians blind to patient plan).
The Clinton administration's health care reform bill proposes three types of health care plans, health maintenance organizations (HMOs), preferred provider organizations (PPOs) and the traditional fee-for-service plans (FFS).
Fee-for-service plans (also called indemnity plans): Plans that permit the patient to seek care from any provider, whose bill is then submitted to the insurer for payment under the terms required by the insurer.
The GHAA data predict that the number of people choosing HMOs could reach 50 million by the end of this year, including many consumers who will be switching from old-style fee-for-service plans.