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 ?
Cyrus has already established partnerships with downstream revenue-sharing components and has successfully engaged in several fee-for-service projects with small biotechs, global pharmaceuticals, synthetic biology and consumer product companies.
"I think both providers and payers agree that the fee-for-service model is just not sustainable.
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.
Fee-for-service works optimally where a majority of the population enjoys access to health insurance.
"Depending on the complexity of the USV and the nature of the task, users may be more comfortable with a fee-for-service approach to use USV instead of outright purchase," says Soon.
The data only include total fee-for-service eligibles rather than the gender and age specific data one would want, particularly for the Medicare disabled population.]
Paying health care providers on a fee-for-service basis is one of the key contributors to the shortfalls in quality and cost that are seen in the current health system, according to such organizations as the Institute of Medicine.
The risk adjustment formula that is used also explains only 11 percent of an individual's fee-for-service costs in the year after risk is assessed.
If you are a Medicare Fee-For-Service physician, provider, or supplier submitting claims to Medicare for payment, this is very important information you need to know.
MFH will continue to receive its funding through public and private insurance and fee-for-service contracts.
Jon Stockmal, a registered nurse with Community Healthlink and a Local 509 steward, said he believes one of management's main objectives during the contract negotiations has been to convert salaried clinicians to fee-for-service workers who don't enjoy the same benefits or job security.