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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 with fee-for-service plans, you need to read policies carefully to determine what services will be covered and what won't.
Private fee-for-service plans may offer supplemental benefits that include payment for some or all of the permitted balance billings amounts and additional services that the plan determines are medically necessary.
Yet, only about 3% of the total Medicare population are enrolled in private fee-for-service plans, according to a hearing statement by Dr.
Even urban and suburban areas with historically high enrollment in private plans have seen the most explosive growth from new private fee-for-service plans.
From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans, with many of those complaints relating to private fee-for-service plans.
Those five plans were managed care plans rather than traditional fee-for-service plans.
Likewise, the implementing regulations of both the DOH and PID, the regulatory entities charged with implementing the requirements of the Act, exclude fee-for-service plans from the definition of managed care.
About $281 million would be saved with changes that include the elimination of fee-for-service plans, which often offer the best benefits.
This program would allow all fee-for-service plans in Medicare to compete with a new entity called the Enhanced Regional Fee For Service plans (EFFS) and Medicare Advantage plans (the old Medicare+Choice) through a premium support program.
For example, total costs for back and spine conditions were 18 percent higher in fee-for-service plans than in provider network plans.
PFFS plans could reduce costs for Medicare beneficiaries because they are based on co-payments, while traditional Medicare fee-for-service plans are based on deductibles and 20% coinsurance.
health insurance market from the traditional prepaid group practice, health maintenance organizations, preferred provider organizations, point-of-service plans, to managed or traditional fee-for-service plans.