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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 ?
On the other hand, HMOs have more of a reputation than fee-for-service plans for attempting to put limits on the care you may receive through various administrative processes and medical review.
Private fee-for-service plans must demonstrate that the plan includes a sufficient number and range of providers willing to furnish services.
These employees selected traditional fee-for-service plans more often than Ppo's and HMO's for nearly every combination of plan types offered.
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).
Other fee-for-service plans require a copayment, usually between 10 and 20 percent of the cost.
Fee-for-service plans have adopted some activities used by HMOs and PPOs to control the use of medical services.
Together, they account for about 90% of enrollment in private fee-for-service plans, according to the CMS.
But they can all be categorized into four basic groups: traditional indemnity or fee-for-service plans, preferred provider organizations (PPO), point-of-service plans (POS) or health maintenance organizations (HMO).
Finally, for fee-for-service plans, the alliances will set a fee schedule for physicians and for hospitals.
Thus, HMOs have a 50% lower rate of hospital stays than fee-for-service plans.
Over 1 million older Americans are now enrolled in private fee-for-service plans, about 2% of all Medicare beneficiaries.
PPO's, a type of fee-for-service plan, allow employees to choose their providers, but give a greater reimbursement if selected providers are used.