What is Fee-for-Service?
Fee-for-Service refers to a medical insurance plan that a person can avail. If a particular person has this type of medical insurance coverage, he/she can basically choose his/her own doctor, clinic, hospital, or any other medical facility and let the insurance provider take care of the payment. These health plans typically are more expensive than basic HMO coverage or other managed care plans.

In typical HMO coverage, members usually go through a designated accredited health care provider to avail of the consultation benefits. Members may also avail of laboratory and other medical services from clinics, laboratories, and facilities that are accredited and part of the HMO coverage. Only those medical services availed from accredited facilities and providers will be covered by the health insurance company. In contrast, those with Fee-for-Service health plans do not have many restrictions when availing of medical services. The insurance company involved will take care of the bills regardless of which doctor or facility is chosen by the member. This concept makes the Fee-for-Service or FFS health plan more expensive than generic health plans.

FFS health plans typically have two main policies or health coverage. The first coverage is called the “basic policy” which comprises all doctor visits, surgery, hospitalization, and other basic medical needs. This part of the policy usually has a set maximum amount or benefit limit. When this part of the coverage is exhausted, the second policy may take over. The second policy is called “major medical coverage” and this involves medical expenses that could reach 250,000 US Dollars or more. This type of coverage is ideal for those that have conditions that require long-term medical treatment. People may opt to only avail of the basic policy and/or the major medical policy. But insurance providers also offer a comprehensive health plan package that combines the two policies mentioned.