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 ?
HMO fees are generally lower than those of fee-for-service plans, but a consumer must have a primary-care physician who makes referrals for further treatment.
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.
Coverage of reversible contraception in PPOs follows a pattern similar to that of conventional fee-for-service plans. Forty-nine percent of PPOs routinely cover no reversible contraceptive method, with 18% covering all five of the reversible methods in the survey.
Each health alliance must offer at least three plans: an HMO plan, a PPO plan, and a fee-for-service plan. But it is important to remember that all three of these plans must cover the same services.
Fee-for-service plans. Participants in fee-for-service plans are provided with the most variations in coverage of outpatient diagnostic x-ray and laboratory tests.
Thus, HMOs have a 50% lower rate of hospital stays than fee-for-service plans.
Today, the rates in all types of HMOs appear to be about 350 days per 1,000 for persons under 65 years of age, and the rates for enrollees in fee-for-service plans are considerably higher, in the low 500s (Group Health Association of America, 1990).
Categories: October 8, 2010, Access to health care, Child care programs, Child health services, Children, Children with disabilities, Claims, Disabilities, Disadvantaged persons, Disease detection or diagnosis, Down Snydrome, Families, Fee-for-service plans, Health care programs, Hospital care services, Medicaid Program, Medical care evaluation, Parents
Medicare Advantage plans also have benefits and services that are not covered by traditional fee-for-service plans.
The Alliance for Health Reform is offering an online booklet that contains links to resources describing the basics of Medicare private fee-for-service plans, advantages and incentives of the plans, and difficulties encountered by beneficiaries.
The Times article charged that the "abusive sales tactics are particularly egregious among private fee-for-service plans," which it said are the fastest-growing type of private Medicare coverage.
CHARGE: Private fee-for-service plans (PFFS) are promoted as allowing you to see any doctor, but in fact many doctors refuse to accept them.