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Medicare Private Fee-For-Service Plans
A Medicare PFFS Plan is a type of Medicare Advantage Plan (Medicare Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
What Is Medicare Prior Authorization?
Medicare uses Prior Authorization to ensure that certain medical services or prescription drugs meet specific coverage criteria before they are approved and paid for. Prior Authorization rules are implemented as cost-saving measures. Medicare wants to ensure that every Medical Procedure is medically necessary for the beneficiary's health.
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