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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.


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 ?
As for preventable ED visits, the rate among the Medicare fee-for-service patients was 15.
For example, plan sponsors will have to show that all of their advertising, marketing, and enrollment materials include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as traditional Medicare or Medigap and that not all providers will accept the plan.
Range of services: The fee-for-service provider should offer a full range of commercial mortgage loan services and be committed to developing a solution for the client.
Providers are paid on a fee-for-service basis and are not subject to utilization review
Between 1985 and 1998, HCFA's reimbursement rate for HMOs was set at 95 percent of the cost of serving an enrollee in Medicare's fee-for-service (FFS) sector.
Over 87 percent of the Medicare population receive their care in the fee-for-service sector, and 13 percent are enrolled in Medicare managed care plans (Table 1 and Figure 1).
Studies have consistently shown that HMO patients are at least as satisfied with their care as patients receiving traditional fee-for-service care.
Under traditional fee-for-service plans, patients can choose to see any doctor at anytime and pay them a fee directly for their service and wait to be reimbursed, as Kevin Holston did, usually for 80% of the cost.
For those on fee-for-service plans, RAND found decreased service use and per-patient cost from 0% to 25% cost sharing (but no further decrease for more cost sharing).
Staff of the Ann Arbor CIL have also begun implementing an independent living-oriented, fee-for-service "case management" program to enhance access to and effective use of health and rehabilitation services by people with disabilities.
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.
Most employees are familiar with fee-for-service plans, the prevailing benefit offering for years.