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 ?
Although on average, premiums have risen faster for HMOs than for fee-for-service plans in FEHBP, their total cost to an enrollee is usually far lower.
All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.
Thus, one would expect managed fee-for-service plans to have hospital days per 1,000 in the mid-400s per 1,000 enrollees.
As government contributions sink, private fee-for-service plans can provide an escape hatch from rationing.
Prior research has shown that some prepaid forms of health care financing incur lower utilization/expenditures than fee-for-service plans for outpatient mental health care (Diehr, Williams, and Martin 1984; Wells, Manning, and Benjamin 1986; Norquist and Wells 1991).
Employees enrolled in HMO'S pay a lower percent of their total costs in out-of-pocket expenses than do employees covered by a fee-for-service plan because of the different structures of these plans.
Only 14% of workers are enrolled in health maintenance organizations (HMOs), 9% in a point-of-service (POS) plan, and less than 1% in a conventional fee-for-service plan. Also of interest to physicians:
Under a fee-for-service plan, you and your insurance company each pay a portion of your health care expenses.
Since the 1980s, people eligible for Medicare have been able to choose between the regular fee-for-service plan, under which the federal government pays a set fee to health care providers for each service provided, and Medicare Advantage (MA), whereby the government pays private health plans a fee for each individual they enroll.
Discount: This option is a fee-for-service plan that offers a range of discounts for all levels of treatment including orthodontics.
What is a Medicare Advantage private fee-for-service plan?
Most Medicare beneficiaries can choose to receive benefits through the original Medicare fee-for-service program, or through a coordinated care plan (including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Provider-Sponsored Organizations (PSOs)), or a private fee-for-service plan that reimburses providers on a fee-for-service basis.