Task a day insurance: Considering a PFFS? Watch out for out of pocket expenses and the risk that your insurance won't be accepted by physicians.
http://www.medpac.gov/documents/062807_Housebudget_MedPAC_testimony_MA.pdf
is one website that describes the drawbacks of the Private Fee For Service Health insurance plans. On page 12, there is a table that compares the PFFS plans to other kinds of Medicare choices.
The PFFS plan is being marketed as a great choice because of physician choice for patients. However, consider that building a network of providers that accept the PFFS plan is not required, limits on out of pocket expenses are not a requirement and reports of quality measures is not required. Of these, consider that building a network of providers is not required.
On the surface, this makes sense, after all, any medicare provider is deemed a PFFS plan provider if he sees a patient with PFFS insurance. The issue is that physicians are already considering NOT accepting patients with this insurance, which is their choice. Second, without limits on out of pocket expenses or co-pays, this can get expensive.
Policy: Wherever you stand on the issue, our system does not provide that physicians accept any insurance plan. In exchange for getting quantity of patients belonging to a particular health plan, physicians have been willing to negotiate their rates with insurers to a less expensive amount. However, with the shift in health insurance to individual rather than group, this leverage is disappearing as people flock to any variety of health insurance plans. Medicare has been protected up until now, as are individuals who participate in HMO/PPO's because there are requirements that these plans work to develop a network of participating providers so that plan members can use participating providers. Not so with the PFFS. By changing the language of participating provider into "deemed" participants, consumers are being sold the "opportunity" to use any provider and have that provider be considered as a member of their plan for reimbursement rates. All well and good except the providers don't have to accept that deal.
