QUESTIONS ABOUT INSURANCE

Traditional fee for service plans pay for each service as it is rendered according to a set fee schedule. The insurer pays for each service rendered upon receipt of a claim form and bill which indicates the charge.

When you subscribe to a fee-for-service plan you are not required to have a primary care physician (PCP). You can seek services from any provider without a referral and the carrier will pay the agreed upon fee. You may be required to obtain a second opinion, however, this is usually fulfilled by the provider.

A comprehensive fee for service plan will generally provide coverage for medical services regardless of the provider from whom you seek services, unless there is an arrangement with the provider and the insurer that designates that provider as a participating provider for that insurer. In those circumstances you will be instructed to seek services from the participating provider to insure payment at 100%.

Some plans will impose a deductible, which is the initial annual out-of-pocket expense the you must pay before services are covered by the carrier.

Other plans might cover expenses at an 80/20 ratio, which means that the carrier will pay 80% of the fee while you pay 20% of the fee.