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Get Blue Medicare Private-Fee-For-ServiceSM (PFFS)
2 Provider Participation The Deeming Process ......................................................................2 Additional Deemed Provider Requirements ............................................................................3 Summary of Benefits ...............................................................................................................4 Claims Submission Procedures .
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SNF FAQ
A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan, offered by a State licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services (CMS) to provide beneficiaries with all their Medicare benefits, plus any additional benefits the company decides ...
Fee-for-service is a system of health care payment in which a provider is paid separately for each particular service rendered. Original Medicare is an example of fee-for-service coverage.
Disadvantages of PFFS plans However, premiums with a PFFS plan can cost more than original Medicare, and copayments and coinsurance costs might be high if you go out of network. Also, some providers might not accept your PFFS plan, and some services might be covered while others are not.
PPO plans allow you to go outside of your network, but the cost may increase. PFFS plans let you go outside of your network if the doctor or hospital accepts the payment terms and agrees to treat you, and SNPs* generally require you to stay in your network.
Private Fee-for-Service (PFFS) Plans.
PFFS is a type of Medicare Advantage plan provided by a private insurance company where medical coverage is often bundled with prescription drug benefits and extras like dental. Original Medicare, also called Parts A and B, is provided directly through the government.
HMO plan members will lean on the guidance of their primary care doctor and in most cases will not be able to visit a specialist without a referral from this physician. There is typically no need to obtain a referral in order to make an appointment with a specialist when you have a PFFS plan.
Private fee-for-service (PFFS) plans are a type of Medicare Advantage plan sold by a private insurance company, and they have a limited network of providers. In contrast, Original Medicare also uses a fee-for-service billing model, but it's administered by the federal government and is widely accepted by most doctors.
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