Private Fee For Service (PFFS)

What is FirstCare Advantage Private Fee For Service?

FirstCare Advantage Platinum Plus, Advantage Platinum Choice, Advantage Value Plus, and Advantage Value is a Medicare Advantage private fee-for-service (PFFS) plan authorized by the Centers for Medicare and Medicaid Services (CMS).  A PFFS plan is different than Original Medicare or an HMO, PPO, or Medicare supplement plan.

FirstCare Advantage gives you the ability to choose your health care provider.  However, not all providers may accept this plan, even Medicare providers may not accept this plan.  If you choose this plan, it is very important that all the providers you choose know, before providing services to you, that you have FirstCare Advantage coverage in place of Medicare.  This gives your provider the right to choose whether or not to accept the FirstCare Advantage's terms and conditions of payment for treating you.  Providers have the right to decide if they will accept FirstCare Advantage each time they see you.  This is why you must show your FirstCare Advantage ID card every time you visit a health care provider.

• If your provider agrees to FirstCare Advantage's terms and conditions of payment;
  If your provider decides to accept the FirstCare Advantage PFFS plan, they must follow our plan's terms and conditions for payment.  They must thereafter bill FirstCare for those services.  However, providers have the right to decide if they will accept FirstCare Advantage PFFS plan each time they see you.  The only cost-sharing that is required of you is the plans co-payment or co-insurance at the time of service.
• If your provider does not agree to FirstCare Advantage's terms and conditions of payment;
  A provider may decide not to accept FirstCare Advantage's terms and conditions of payment.  If this happens, you will need to find another provider that will.  You may contact us at 1-866-229-4969 for assistance locating another provider in your area who is willing to accept our plan's terms and conditions of payment.  The provider should not provide services to you except for emergencies.

For more information about PFFS plans see Beneficiary Qs & As at CMS's web site http://www.coms.hs.gov/PrivateFeeForServicePlans/.  If you have questions about FirstCare Advantage, please call our customer service department at 1-866-229-4969, Monday through Friday, 8:00 a.m. - 8:00 p.m. central.

Compare our Advantage PFFS plans!

 A Medicare Advantage Private-Fee-for-Service plan works differently than a Medicare supplement plan.  Your doctor or hospital must agree to accept the plan's terms and conditions prior to providing healthcare services to you, with the exception of emergencies.  If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies.  Providers can find the plan's terms and conditions by calling us at 866-229-4969.

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Last Updated:(2/22/2008)