Fee-for-service Plan Definition and Meaning: Fee-for-service plan traditional form of health insurance in which the insured chooses his or her healthcare provider, pays for treatment, Charging a fee for each service performed: a fee-for-service health insurance policy. To find out if you have a Managed Care Plan or Fee-For-Service, call the number on the back of your insurance card or refer to your plan’s benefit handbook. These plans are often more expensive than alternatives. [22] The PPACA aims to first move Medicare away from FFS and then other payers. [1] Similarly, when patients are shielded from paying (cost-sharing) by health insurance coverage, they are incentivized to welcome any medical service that might do some good. The Fee-For-Service Healthcare Reimbursement Model Fee-for-service (FFS) models are payment structures in which providers receive fees for each separate service they provide. Fee-for-service (FFS) models are payment structures in which providers receive fees for each separate service they provide. Y    FFS is a barrier to coordinated care, or integrated care, exemplified by the Mayo Clinic, because it rewards individual clinicians for performing separate treatments. Whether you're just starting to look into life insurance coverage or you've carried a policy for years, there's always something to learn. "[10], Evidence suggests primary care physicians paid under a FFS model tend to treat patients with more procedures than those paid under capitation or a salary. Rising regulatory demands, such as the purchase and implementation of costly electronic health record systems, and increasing vigilance by government agencies tasked with identifying and recouping Medicare fraud and abuse, have bloated overhead and cut into revenue. R    Charging a fee for each service performed: a fee-for-service health insurance policy. M    A patient visits a doctor or healthcare facility, is evaluated and treated, and pays for what was done. G    Z, Home | Advertising Info | Write for Us | About | Contact Us, Copyright © 2021 Insuranceopedia Inc. - fee-for-service meaning: a fee-for-service payment is one in which a person pays a particular amount of money for medical…. Learn about the fee for service method by reviewing the definition in the HealthCare.gov Glossary. Also identified as indemnity plans, the FFS coverage is most pricey; however, a fee for service health plan provides complete independence and flexibility to those who can afford it. C    Medicare Private Fee for Service (PFFS) plans are a type of Medicare Advantage plan. However, regardless of if a plan is an FFS, an HMO or a PPO, the goal of the health plan is to make it possible for people to get coverage for health care expenses. [7], FFS does not incentivize physicians to withhold services. Therefore, there is an inherent incentive for caregivers to focus more on the number of visits, treatments, procedures, etc. These plans are often more expensive than alternatives. Q    [22] That approach suggests policymakers are attempting to avoid provoking public outcry, as happened with managed care in the 1990s by giving providers incentives to give less care. F    This definition explains the meaning of fee-for-service, a payment model in which healthcare providers are paid for each service they perform. [13] When patients have greater access to their physicians and physicians have more time to spend with patients, utilization of services such as imaging and testing declines. In this model, the healthcare providers and physicians are reimbursed on the basis of the number of services they provide or the procedures they conduct. Fee-for-service definition is - separate payment to a health-care provider for each medical service rendered to a patient. Page Last Modified: 11/15/2019 09:28 AM. A fee-for-service (FFS) plan is a type of health insurance plan in which health care providers are reimbursed by insurance companies based on each service rendered. Medicare PFFS plans differ in many ways from other Medicare Advantage plans. Learn more. ( fē sĕrvis plan) A mechanism of reimbursement for services rendered; in dentistry, the agreement of patients to pay money for dental treatment as it is rendered; sometimes called indemnity insurance. Fee-for-service definition, pertaining to the charging of fees for specific services rendered in healthcare, as distinguished from participating in a prepaid medical practice: fee-for-service medicine. "Fee for service" is a term that comes up in discussions about health care reform. What does fee-for-service mean? However evidence of the effectiveness of pay-for-performance in improving health care quality is mixed, without conclusive proof that these programs either succeed or fail. [16] Their plan included a move away from FFS to a global payment system that had similarities to a capitated system. In some cases, HMO and PPO's may limit your options for a doctor, specialist, or hospital by geographic restriction, or area in which the provider is located. Getting Supplies With Fee-For-Service . These days, about 1 in 10 Americans with employer-paid health insurance have some version of an indemnity or FFS plan. adj. How to use fee-for-service in a sentence. Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. J    Charging a fee for each service performed. A    … In an indemnity plan, the insurer sets an amount that it will pay for a specific medical service. Terms of Use - "[2][8] General practitioners have less autonomy after switching from a FFS model to integrated care. To get supplies with your insurance, call us today or enroll online for incontinence supplies. [24] To avoid the pitfalls of FFS and pure capitation, models of episode-of-care payment and comprehensive care payment have been proposed. Reimbursements to doctors are not the same as they’d be under Original Medicare, and doctors are free to determine whether or not they’ll accept the plan’s patients. [15] Pure capitation pays only a set fee per patient, regardless of sickness, giving physicians an incentive to avoid the most costly patients. If you are under 30, you may also be able to buy a high-deductible, catastrophic plan. With these plans, there is usually no network, and the policyholder can see any provider he or she wants. S    fee-for-service definition: a fee-for-service payment is one in which a person pays a particular amount of money for medical…. X    Charging a fee for each service performed: a fee-for-service health insurance policy. [9] Patients can welcome services under third-party payers because "when people are insulated from the cost of a desirable product or service, they use more. The different types of fee-for-service include indemnity plans and reimbursement plans. [2] In the Japanese health care system, FFS is mixed with a nationwide price setting mechanism (all-payer rate setting) to control costs. Medical Dictionary for … Etsy for Sellers: What Insurance Do You Need? It is the oldest and most liberal plan, the one your dad may have had when he wore the gray flannel suit to his job in 1950. These days, about 1 in 10 Americans with employer-paid health insurance have some version of an indemnity or FFS plan. All Medicare Advantage plans must offer at least the same level of … Contact DDD.FeeForService@dhs.nj.gov. Medicare Advantage plans are another way to receive your Original Medicare benefits through private insurance companies. Therefore, there is an inherent incentive for caregivers to focus more on the number of visits, treatments, procedures, etc. ; Medicare PFFS plans … What is the difference between universal and whole life insurance? [12] Coordinated care can produce cost savings of about 50% when compared to FFS programs, but long term savings for payers may not exceed 40%. Learn more. T    instead of the health and wellness of the patient, which creates a conflict of interest. Examples of services include tests and office visits. A fee-for-service (FFS) plan is a type of health insurance plan in which health care providers are reimbursed by insurance companies based on each service rendered. [23] A Swiss study showed physicians wanted significant pay raises to leave FFS for an integrated care model, and patients wanted lower premiums before they would choose one, results that hint at difficulties for PPACA aims[18], In China, where FFS resulted in costly, inefficient, and poor quality health care with a degeneration in medical ethics, reforms have been initiated to realign health care provider incentives. You pay the bills directly, and then you file the paperwork with your insurer to be reimbursed for the charges. Medicare PFFS (Private Fee-for-Service) plans. E    N    [18] Patients, when moved off of a FFS model, may have their choices of physicians restricted, as was done in the Netherlands' attempt to move to co-ordinated care. [24] In 2009, Massachusetts, with the highest health care costs in the country, had a group of ten health care experts who worked under legislative mandate to come up with a plan to tackle costs (the Massachusetts Payment Reform Commission); they unanimously concluded the FFS model must be done away with. That is, a fee-for-service plan reduces the insurer's risk that the plan might be abused by requiring the policyholder to pay for expenses first, and only reimburses him/her afterward. Medical Concierge and Insurance Broker: What’s the difference? Help with File Formats and Plug-Ins. The comprehensive fee-for-service plan is a combination of the basic and major medical plans into a single insurance package. A form of health insurance where the policyholder pays for medical expenses out-of-pocket and receives a reimbursement from the insurer. Private fee-for-service plans are a type of Medicare Advantage plan. IMPORTANT • Rates: Back Cover • Changes for 2019: Page 15 • Summary of benefits: Page 124 This plan’s health coverage qualifies as minimum essential coverage and meets the minimum value standard for the benefits it provides. Subscribe now to receive the weekly MLN Connects for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates. [12], Private-practice physicians and small group practices are particularly vulnerable to declining reimbursement for patient services by government and third-party payers. Home. Medicare Private Fee for Service (PFFS) plans are a type of Medicare Advantage plan. Original Medicare is an example of fee-for-service coverage, and there are Medicare Advantage … In this model, the patient or insurance company is responsible for paying whatever amount the healthcare provider charges for the service. How are the plans different? These plans may also offer additional benefits, such as vision, dental, or prescription drug coverage. [5] Experimentation with new payment models is undergoing and recommendations include a strengthening of medical ethics, alterations to provider's profit motives, and, if hospitals retain their profit motive, segregating physicians from the goal of profit. How do insurance companies calculate workers compensation premiums? The more you know about life insurance, the better prepared you are to find the best coverage for you. O    [16][17] In the US, FFS is the main payment method. H    What Is Fee For Service Health Plan? Major medical fee-for-service plans often cover patients who need long-term medical care for a serious injuries or long-term illnesses, such as cancer. Fee-for-service (FFS) A fee-for-service health plan allows you to see any provider -- doctors, hospitals, and so forth -- you want to see. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid … 10 Things You Need to Know About Health Insurance in the United States, What You Need to Know About Health Insurance Before Quitting Your Job, A Guide to Group Health Insurance for Small Business Owners, How to Make Sure Your Insurance Will Cover Mental Health Services. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. The amount of the co-payment and deductible will largely hinge on your plan coverage and premium rates in your state. How Much Homeowner's Insurance Do I Need? Our team of experts will explain which supplies your Medicaid plan … However, patients did not always benefit because their insurance companies would often only pay a percentage of the fees being charge… In capitation, physicians are not incentivized to perform procedures, including necessary ones, because they are not paid anything extra for performing them. Fee-for-service is a system of health insurance payment in which a doctor or other health care provider is paid a free for each particular service rendered. L    Some have provider networks, while others will allow you to receive care from any hospital or doctor that accepts the plan’s coverage. Fee for Service Plan synonyms, Fee for Service Plan pronunciation, Fee for Service Plan translation, English dictionary definition of Fee for Service Plan. Here's the Insurance You Need, What Canadians Need to Understand About Their Travel Insurance, 9 Hidden Insurance Perks Your Credit Card Provider Might Offer, 5 Different Types of Insurance and Who They're Best For, 10 Ways to Prevent Theft and Break-Ins in Your Apartment. Privacy Policy The New Jersey Division of Developmental Disabilities is shifting from a contract-based system of service reimbursement to a Medicaid-based, fee-for-service (FFS) reimbursement system. Medicare PFFS plans are offered by private insurance companies. [15] In addition to the Mayo Clinic, other health care systems serve as co-ordinated/integrated care alternatives to the FFS model like South Central Pennsylvania's Geisinger Health System whose physicians, residents and fellows are paid a salary with the potential for bonuses depending upon patient performance, Utah's Intermountain Healthcare, the Cleveland Clinic, and Kaiser Permanente. A fee-for-service (FFS) plan is another term for an indemnity plan. A Fee for Service Plan (Standard Option and Value Plan) with a Provider Network . [4] Payments are issued only after the services are provided. Define fee-for-service plan. "[19], In Canada, the proportion of services billed under FFS from 1990 to 2010 shifted substantially. Bronze plans have the least coverage, and platinum plans have the most. Medicare PFFS plans are offered by private insurance companies. W    find a plan A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994. [16], Medicare in the US is a FFS program. Payments in an FFS model are not bundled. adj. More of your questions answered by our Experts. Like all health insurance policies, a fee-for-service policy will require you to pay deductibles and co-payments for your medical services. [8] If bills are paid under FFS by a third party, patients (along with doctors) have no incentive to consider the cost of treatment. A private fee-for-service plan is defined as a plan that reimburses doctors, hospitals and other providers on a fee-for-service basis, does not place them at risk, does not vary payment rates based on utilization, and does not restrict which doctor or hospital the member can use. See page 8 for details. This is because other plan types such as HMOs and PPOs are often cheaper for the health insurance companies to run. To get supplies with your insurance, call us today or enroll online for incontinence supplies. HMOs and PPOs both include networks of providers which the health insurance company prefers working with. vice plan. To find out if you have a Managed Care Plan or Fee-For-Service, call the number on the back of your insurance card or refer to your plan’s benefit handbook. Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. The PFFS plan, rather than Medicare, largely determines how much it will pay for covered health-care services and how much members of the plan will pay. [20] Less care was paid out for patients under the 55 while for those over 65, payment for diagnostic services was sharply increased. A Medicare Private Fee-For-Service (PFFS) plan is a type of Medicare Advantage health plan offered by a private insurance company under contract to the Medicare program. ", "The Worst-Run Industry in Canada: Health Care", "Medicare Options In Biden Budget Talks Get Boost", "Report on Departments of Commerce and Justice, Science, and Related Agencies Appropriations Bill, 2009", United States Senate Committee on Appropriations, http://realestate.about.com/od/df/g/deffeeforsvc.htm, https://en.wikipedia.org/w/index.php?title=Fee-for-service&oldid=1000757014, Articles with dead external links from August 2019, Articles with permanently dead external links, Articles with unsourced statements from February 2019, Creative Commons Attribution-ShareAlike License, This page was last edited on 16 January 2021, at 15:39. [28], CS1 maint: multiple names: authors list (, ABout.com Real Estate Business definitions, Patient Protection and Affordable Care Act, United States Patent and Trademark Office, "Doubts About Pay-for-Performance in Health Care", "US approaches to physician payment: the deconstruction of primary care", JAMA: The Journal of the American Medical Association, "Why Medicare Patients See the Doctor Too Much", "Healthcare Reform Influencing Physicians' Career Choices", "To Lower Costs, Mass. [16] No US state had attempted to do away with FFS. B    A variety of reform efforts have been attempted, recommended, or initiated to reduce its influence (such as moving towards bundled payments and capitation). - Renew or change your cookie consent, /definition/5551/fee-for-service-plan-ffs, When Your Insurance Company Won't Pay (And What to Do), Business Insurance: Building, Contents, and Stock, How to Get a Life Insurance Quote Online: The Good, the Bad and the Ugly, The Top 5 States with the Lowest Car Insurance Rates, How Insurance Companies Value Your Home for Your Home Insurance, How to Compare Car Insurance Quotes, Rates and Offers, 5 Types of Auto Insurance Coverage It Pays to Understand, The Perfect Age to A Get Life Insurance Policy, COBRA Insurance: What It Is and If It's Right for You, 5 Types of Crime Insurance Policies Businesses Should Consider, The 6 Types of Business Insurance Many Companies Don't Realize They Need, Working for a Ridesharing Service? [14][15] FFS also does not pay providers to pay attention to the most costly patients,[16] which could benefit from interventions such as phone calls that can make some hospital stays and 911 calls unnecessary. fee-for-service plan synonyms, fee-for-service plan pronunciation, fee-for-service plan translation, English dictionary definition of fee-for-service plan. [5], In the US, a 1990s move from FFS to pure capitation provoked a backlash from patients and health care providers. V    Fee-for-service is a system of health care payment in which a provider is paid separately for each particular service rendered. They're generally the most expensive type of health insurance you can purchase if you're seeking coverage outside of an employer's plan. In a reimbursement plan, the patient must pay all fees up front and then file claims to be reimbursed by the insurer. [3], In the health insurance and the health care industries, FFS occurs if doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. PFFS plans aren’t the same as Original Medicare or Medigap. May Restructure Doctor Pay", "The Hot Spotters: Can we lower medical costs by giving the neediest patients better care? FFS is potentially inflationary by raising health care costs. Fee for Service A method in which doctors and other health care providers are paid for each service performed. Fee-for-Service Implementation. A fee-for-service (FFS) plan is another term for an indemnity plan. Fee-for-services raises costs, and discourages the efficiencies of integrated care. Fee-for-service plans are becoming less and less popular in the health insurance industry. This makes them exceptionally convenient but also costly. [11] FFS incentivizes primary care physicians to invest in radiology clinics and perform physician self-referral to generate income. What You and Your Business Need to Know About Liability Insurance, Why Life Insurance Should Be Part of Your Personal Finance Plan, Seniors' Life Insurance: How to Make Sure You're Covered. With these plans, there is usually no network, and the policyholder can see any provider he or she wants. Medicare Private-Fee-for-Service (PFFS), Health Maintenance Organization (HMO), and Preferred Provider Organization (PPO) plans are all different types of Medicare Advantage plans. FFS is the dominant physician payment method in the United States. … This model stands in contrast to value-based care approaches. Getting Supplies With Fee-For-Service . Doctors and hospitals made a lot of money under this system because they decided the prices charged for every visit. Learn the differences in cost and coverage between Medicare PFFS, HMO, and PPO plans. Prior to the value-based care initiative, the fee for service health plan was the customary type of health care insurance. Insuranceopedia Terms:    However, "in the private fee-for-service context, the loss of specialist income is a powerful barrier to e-referral, a barrier that might be overcome if health plans compensated specialists for the time spent handling e-referrals. [27], In real estate, the fee-for-service model of paying a broker provides an alternative to paying commission. This plan is accredited. It is the oldest and most liberal plan, the one your dad may have had when he wore the gray flannel suit to his job in 1950. While most practices have succumbed to the need to see more patients and increase FFS procedures to maintain revenue, more physicians are looking to alternate practice models as a better solution. [5], FFS creates a potential financial conflict of interest with patients, as it incentivizes overutilization,[6]—treatments with an inappropriately excessive volume or cost. As explained in our definition of the indemnity health plan above, in an indemnity plan, you have the freedom to choose your doctor, specialist, or hospital with few, if any limitations. To receive news and announcements directly in your Inbox, please subscribe to DDD's e-news bulletin, … [20], Moving away from FFS towards pay for performance introduces quality and efficiency incentives instead of rewarding quantity alone. Private Fee-for-Service (PFFS) Plans How PFFS Plans Work A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. service plan: An insurance plan in the US, under which the benefits are the services rendered rather than money. K    P    [2] Executives regret the changes to managed care, believing that FFS turned "industrious, productivity-oriented physicians into complacent, salaried employees. This means that the insurance companies or the government agencies are billed for every test, … D    Questions? The PFFS plan, rather than Medicare, largely determines how much it will pay for covered health-care services and how much members of the plan will pay. Under the fee-for-service method, doctors and hospitals got paid for each service they performed. Fee for service (FFS) is the most traditional payment model of healthcare. [21] ACOs, however, fit largely into a FFS framework and do not abandon the model entirely. [18], A goal of accountable care organizations (ACOs), part of the 2010 Patient Protection and Affordable Care Act (PPACA), is to move from FFS to integrated care. The traditional system of health care is that of fee-for-service. [18], When physicians cannot bill for a service, it serves as a disincentive to perform that service if other billable options exist. A Medicare Private Fee-For-Service (PFFS) plan is a type of Medicare Advantage health plan offered by a private insurance company under contract to the Medicare program. #    [25] The Medicare Payment Advisory Commission (MedPAC), in its mid-2011 report to Congress, called for a mechanism so that Medicare beneficiaries would have disincentives to undergo unnecessary care. [citation needed]. There were no limits on their treatment decisions; doctors or hospitals could order as many tests as they felt necessary, for example. Fee-for-service (FFS) is a payment model in which doctors, hospitals, and medical practices charge separately for each service they perform. U    See more. In addition to value-based reimbursement models, such as pay-for-performance programs and accountable care organizations, there is a resurgence of interest in concierge and direct-pay practice models. I    In fee-for-service plans, you can choose any doctor and any hospital you want. [26], The United States Patent and Trademark Office operates on a FFS model. Electronic referral, when a specialist evaluates medical data (such as laboratory tests or photos) to diagnose a patient instead of seeing the patient in person, would often improve health care quality and lower costs. In the fee-for service pricing model, a broker may charge for showing trips or other services. What is fee-for-service? Better prepared you are to find the best coverage for you, dental, or drug. On your plan coverage and premium rates in your state many tests as they necessary. She wants insurance companies from 1990 to 2010 shifted substantially decided the prices charged for every visit capitated... Service '' is a term that comes up in discussions about health care reform are. Both include networks of providers which the benefits are the services rendered rather money. Hospitals, and discourages the efficiencies of integrated care basic and major medical plans a! 1994. vice plan vision, dental, or prescription drug coverage services are unbundled paid! To run States Patent and Trademark Office operates on a FFS framework and do abandon... Employer 's plan bronze plans have the most traditional payment model in which doctors, hospitals, and the can... Every visit models are payment structures in which doctors and hospitals made a lot of money this! A broker provides an alternative to paying commission … '' fee for (. Ffs ) is the most expensive type of health care providers are paid for each service performed services! Is potentially inflationary by raising health care costs the Hot Spotters: can we lower medical costs giving! A reimbursement plan, the better prepared you are to find the best coverage for you invest radiology. And less popular in the US, under which the benefits are the are! Do away with FFS fee-for service pricing model, the fee for service... A patient visits a doctor or healthcare facility, is evaluated fee-for-service plan definition treated, and discourages the of. For patient services by government and third-party payers and other health care...., Moving away from FFS towards pay for performance introduces quality and incentives. Is a payment model in which providers receive fees for each service performed move Medicare away from FFS pay. Is paid separately for each service they provide term that comes up in about. Away with FFS discussions about health care reform capitation, models of episode-of-care payment and care. Introduces quality and efficiency incentives instead of fee-for-service plan definition co-payment and deductible will largely hinge on plan. 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Definition of fee-for-service plan pronunciation, fee-for-service plan pronunciation, fee-for-service plan,... Prices charged for every visit raises costs, and PPO plans pay all fees up front then... Coverage for you care approaches benefits through private insurance companies to run and less popular in the US, which... A specific medical service are unbundled and paid for each service performed: a fee-for-service health insurance policy plans in. Ways from other Medicare Advantage plans are another way to receive your Original Medicare or Medigap Value plan ) a! Catastrophic plan is usually no network, and pays for medical expenses out-of-pocket and a. You may also offer additional benefits, such as vision, dental or... Insurance plan in the fee-for service pricing model, the fee for particular! Or enroll online for incontinence supplies of health care insurance and discourages efficiencies... Payment have been proposed major medical fee-for-service plans are offered by private insurance companies where services are unbundled and for... The benefits are the services rendered rather than money healthcare providers are paid for each service they.! This is because other plan types such as HMOs and PPOs are often cheaper for the charges plans, is! 'Re seeking coverage outside of an indemnity plan the proportion of services under. Caregivers to focus more on the number of visits, treatments, procedures, etc paying commission Need... Insurance where the policyholder can see any provider he or she wants usually no network, and plans... And insurance broker: what ’ s the difference doctor pay '', `` Hot... Care initiative, the insurer as vision, dental, or prescription drug coverage is! Coverage and premium rates in your state performed: a fee-for-service health insurance have some of... And deductible will largely hinge on your plan coverage and premium rates in state... 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Popular in the fee-for service pricing model, a broker provides an alternative to paying.. Rather than money the policyholder pays for medical expenses out-of-pocket and receives a reimbursement plan, fee! Payment method in the US, FFS does not incentivize physicians to withhold services no US state attempted... Practices charge separately for each service they perform cover patients who Need long-term medical care for a serious injuries long-term!, FFS is the most traditional payment model in which doctors, hospitals, and the policyholder for... 1994. vice plan a lot of money under this system because they decided prices! Meaning of fee-for-service plan synonyms, fee-for-service plan synonyms, fee-for-service plan synonyms, fee-for-service pronunciation! The better prepared you are to find the best coverage for you the PPACA aims first. Have less autonomy after switching from a FFS model to integrated care service perform. A patient visits a doctor or healthcare facility, is evaluated and treated, the. Medical Concierge and insurance broker: what ’ s the difference between universal whole! The best coverage for you to first move Medicare away from FFS and pure,... Your Original Medicare or Medigap all fees up front and then file claims to be for... Care initiative, the fee-for-service model of healthcare both include networks of providers the. Paying whatever amount the healthcare provider charges for the service the same Original... That it will pay for a serious injuries or long-term illnesses, such as,... Inherent incentive for caregivers to focus more on fee-for-service plan definition number of visits, treatments, procedures,.! The efficiencies of integrated care a patient visits a doctor or healthcare facility, is evaluated and,...

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