Question

Describe the principles of fee-for-service plans and managed care plans. What are the similarities and differences? DO NOT PLAGIARIZE. ORIGINAL ANSWER ONLY

Answer 1

Fee for service plans is medical plans in which the insurer chooses the physician and hospital, gets the treatment and pays the bills directly to the hospital for the services taken. He then files the bills and claims for reimbursement from the insurance company. They are convenient but costly plans. They include co-payments and deductibles and only a partial amount is paid by the insurer. Physicians and insurers are responsible only for the care which is indicated for the patient. The insurer is only responsible for the payment of the bills and not the overall health of the insuree. Physicians make decisions over what treatment the patient should be getting.

In managed-care plans, insurance companies have tie-ups and agreements with certain doctors and hospitals and the patient can get services from these only. It is less costly as the patient only has to pay a minor amount while visiting the doctor and the total fees and paperwork is handled between the physicians or hospital and the insurer. HMO, PPO and POS are different types of managed care plans. Physicians cannot make decisons over the care to be given to patients and management systems make this decision.

They are both medical plans managed partially by the state and insurers and partially by the insuree. They are both focused on treating sick patients and improving health care quality. They are systematic medical care plans which include payments or premiums by patients and paperwork to get claims or reimbursements.

The differences between FFS and managed care plans are:

- under FFS you can choose the physician you want to go to, under the managed care you can only select from physicians affiliated with the plan

- under FFS you can see a specialist if you feel it necessary and under the managed care plan a specialist has to be referred by the physician if he finds it required.

- FFS does not cover all the periodic checkups whereas managed care covers the periodic checkups by a primary care physician and also get reminders for the screen-tests

- In FFS the payment is deducted yearly after which the person is asked to pay the bill upfront after which he will submit later as a claim for reimbursement. In managed-care, a minimum amount is paid when seeing a physician after which he does the paperwork for the plan.

- In FFS, it is on you to look for the best physician, determine their qualifications and credentials and decide to get treatment from him. The plan plays a role in only the payment of claims. In managed-care, the plan takes the responsibility of determining the suitable doctor and their qualifications and will take your opinions on the quality of care you received.