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 ?
If the Medicare fee-for-service program offered enrollees the kind of annual out-of-pocket spending cap that Affordable Care Act-compliant private major medical plans now provide, "the addition of an annual cap would reduce the need of some beneficiaries to purchase supplemental insurance," James Cosgrove, a GAO director, writes in a new GAO report.
Incorporating quality metrics into fee-for-service contracts.
Based on an average payment per discharge of nearly $8,400 in 2007, bringing Medicare's fee-for-service preventable hospitalizations down to the same level as the ACHP plans would have saved the program $4.
But, he noted in his opening statement that in Montana, more than 90% of all Medicare Advantage enrollees are in private fee-for-service plans, rather than in the health maintenance organizations or preferred provider organizations.
The seven private fee-for-service Medicare plans that recently signed an agreement with the CMS to suspend their marketing efforts are United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee.
At its best, a fee-for-service provider is a partner in the client's business, providing the contracted services today and looking toward improvements to meet future needs.
This might be a more cost-effective solution and offer a higher quality of life than prescribing costly medications or continually hospitalizing the individual when she has asthmatic attacks-which would be the only possible interventions under fee-for-service Medicare.
Congress authorized private fee-for-service plans in the Balanced Budget Act of 1997 as an alternative way to provide flexible coverage with affordable premiums to Medicare benefiaries.
INNOVATIVE HMO NURSING HOME PROGRAMS may have the potential to keep more nursing home residents out of emergency rooms and hospitals, ultimately providing better care at a lower cost than traditional fee-for-service (FFS) programs.
On the basis of little more than HMO assertions that they were more efficient than Medicare, HCFA set the HMO reimbursement rate 5 percent below the rate at which HCFA reimburses doctors and hospitals in the traditional, fee-for-service Medicare program.
The project will give Medi-Cal beneficiaries enrolled with the California Children's Service program the option of staying on a fee-for-service plan or switching to one of the two health care plans.
That report focused on the elderly population living in the community who received care in the fee-for-service sector.