What is the maximum amount Dr. Morgan can charge Mary Rogers for treatment under the ABC PFFS plan?

The maximum amount Dr. Morgan can charge Mary Rogers for treatment under the ABC PFFS plan is determined by the cost sharing specified in the plan's terms. In a Private Fee-for-Service (PFFS) plan, the provider can set their rates but they must adhere to the terms outlined in the plan, which include co-payments, coinsurance, and deductibles. Cost sharing refers to the portion of healthcare costs that the member is responsible for, beyond the premiums paid for the insurance.

This principle is essential because PFFS plans are designed to ensure that beneficiaries have clear guidelines on what they can expect to pay. As such, any charges from Dr. Morgan must align with what is established in the plan documents, ensuring the member's out-of-pocket expenses do not exceed what the plan has defined as acceptable.

For a PFFS plan, the specifics of the contract will detail how much a provider can charge, including limits based on the Medicare rates or other predetermined amounts. This structure is crucial in protecting consumers from unexpected costs and ensuring they have access to necessary medical services without excessive financial burden.