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 ?
Fee-for-service plans generally include annual deductibles and coinsurance.
When people are permitted to spend their own money for health insurance, and those who can afford it select the more expensive unrationed, unmanaged fee-for-service plans, this adds money to the system.
Slightly more than half of HMO enrollees with outpatient benefits had ceilings on days of coverage, while fewer than one-third of fee-for-service plan participants with outpatient benefits had such ceilings imposed.
For poor patients who initially had some type of illness, 22 percent of those in HMOs and 57 percent of those in fee-for-service plans showed improvements in physical health.
After a decade of growth, nontraditional health care plans such as health maintenance organizations and preferred provider organizations have emerged as viable alternatives to long-established fee-for-service plans.
In 1989, 90 percent of HMO participants and 97 percent of fee-for-service plan participants were in plans that included prescription drug coverage.
Those enrolled in traditional Medicare can sign up for the Part D benefit as a standalone PDP or choose to enroll in a private fee-for-service plan like SecureHorizons Direct and enroll in a complementary Part D prescription drug plan.
Called Secure Horizons Direct, the new private fee-for-service plan will be available beginning Sept.
Additionally, the plans introduce new options for seniors in addition to the traditional fee-for-service plan, and they provide for additional preventive care services.
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.
The company withdrew Sterling Option 1, its Medicare private fee-for-service plan.
The district counters that it wants to use a combination of a fee-for-service plan as well as a flat fee based on a percentage.