What defines a deemed provider in a PFFS plan?

A deemed provider in a Private Fee-For-Service (PFFS) plan is defined as one that agrees to the plan's terms and conditions before delivering services. This agreement indicates that the provider acknowledges and accepts the terms set by the PFFS plan, which includes their payment arrangements and other operational protocols. When a provider becomes deemed, it means they are authorized to serve beneficiaries of the PFFS plan without needing to be in a network, as long as they operate under the agreed-upon terms.

This contractual understanding is essential for maintaining a smooth operational relationship between the plan and the provider, ensuring that the provider will be compensated according to the plan's regulations for the services rendered. This model is designed to give beneficiaries more flexibility in choosing their healthcare providers while also ensuring that the providers are working within the framework set by the plan itself.