Fee-for-Service Plans Explained
Your healthcare options are plentiful these days and it is hard to keep track of new variations and terminology. While it's picked up a new name, Fee-for-Service Coverage, (Indemnity Coverage), is traditional health insurance. The same health coverage your grandparents had with no networks.
In the state of Illinois the choices are a lot more simple, PPO's are the predominate model of providing health care to consumers no matter the plan design. Over 90% of the providers in Illinois belong to a PPO organization so the need to see any provide you wish is usually satisfied, even when you are traveling out of state.
Fee-for-Service coverage offers you a rare level of freedom when it's time to choose a doctor, surgeon, hospital or clinic. You won't have to wait for treatement in a medical emergency or unexpected illness. You do pay a yearly deductible and a coinsurance rate, but once they're fulfilled your insurer will be paying the rest regardless of cost.
What Should I Be Aware Of?
Fee-for-Service coverage is more expensive than an average managed care plan, but it is also more versatile. That is not to say that it will not have restrictions.
For example: Your Fee-for-Service plan may not offer coverage for preventative care; so check-ups, routine office visits, vaccinations, etc. could end up your responsibility. This can make Fee-for-Service plans impractical for large families that only require regular doctor visits and preventative health services.
You need to be aware of usual and customary restrictions, some plans will only cover you for the usual and customary charge, and you are responsible for any overage the provider may charge.
Copays are seldom incuded, but Celtic does offer an any DOC program where you can visit any doctor you choose, but when it come to hospitalization you revert to being back in a network which is fine since virtually all in state hospitals are network members.
How Do I Decide Which Fee-for-Service Plan Is Right for Me?
- Once you pay your annual deductible, you'll share your medical bills with your insurance carrier (your portion is called "coinsurance"). You might pay 20% to 30% of your bills while your insurer pays 80% to 70%. Itýs important to know what your coinsurance rate will be before selecting a plan.
- Most Fee-for-Service plans have "caps" that define the limits of what you pay for healthcare each year. Your cap may be as low as $1,000.00 or as high as $10,000.00 and won't include a monthly premium. You should know exactly what that number is before you commit.
- There are two types of Fee-for-Service plans. Basic Protection, plans pay for hospital rooms, certain supplies and services--such as x-rays and prescription medications, in or out of hospital surgeries and doctors visits. Major Medical plans cover costs such as long, costly illnesses or injuries.
A Fee-for-Service plan offers you care in a crisis that is both comprehensive and immediate. Fee-for-Service plans are great for avoiding the bureaucratic roadblocks or extended waiting periods built into other managed care plans, but are not as economical for large families or single women needing coverage for regular checkups.
Typically the type of person who buys one of these plans lives in an area which does not have PPO providers, or a person who has homes in multiple states which does not fit in well for PPO's in some areas.
Give us a call at 1-800-391-7469 if we can assist you.
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