What is a FFS Plan?

When it comes to health insurance, there is a lot of confusion around the term fee for service and how it is different from other forms of managed care, such as an HMO or PPO. Basically, an FFS, or fee-for-service plan, is exactly what it sounds like: the doctor who treats you is paid a fee for each service rendered to you, the patient. This might seem self-evident, but in some kinds of managed health care plans, such as an HMO, doctors are part of a network and their participation in the health plan is prepaid.

Fee for Service Plan Basics

Fee-for-service plans generally allow you to go outside of the HMO network and contract with doctors and hospitals individually, paying a fee for service. For some patients, this is desirable as it offers you the maximum amount of freedom in choosing a physician. You can go to any doctor you want and change doctors whenever you wish. You still pay a premium, and you are still covered up to your deductible for basic protection and major medical, as long as your health care plan includes comprehensive care.

Disadvantages of Fee For Service Plans

There are a few drawbacks to using a fee-for-service plan that are unattractive to some consumers. Fee-for-service health care tends to be less predictable than staying within an HMO provider network. Your insurer pays only part of your doctor or hospital stay expenses, and you will be billed for the balance, including any requested lab work, or other procedures that are not necessarily covered by your insurance plan. You might also be required to fill out the claim forms yourself, if your doctors office is not within the insurers provider network. Some preventive health care visits, such as well-child care and routine immunizations, may not be covered under this plan. Be sure to check your policy and weigh the pros and cons before deciding on the best health insurance policy for you and your family.