Payor

An entity, such as an insurance company, government program, or individual, responsible for making payments for healthcare services provided to a patient.

 

Third-Party Payor:

An entity other than the patient or healthcare provider that assumes responsibility for covering the cost of medical services, commonly referring to insurance companies and government programs.

 

Commercial Payor:

Private companies or entities that offer health insurance coverage to individuals or groups, playing a significant role in the healthcare reimbursement system.

 

Government Payor:

Public entities, typically at the federal or state level, responsible for funding and administering healthcare programs, including Medicare and Medicaid.

 

Medicare:

A federal health insurance program primarily for individuals aged 65 and older, but also covering certain younger individuals with disabilities.

 

Medicaid:

A joint federal and state program providing health coverage for low-income individuals and families, including pregnant women, children, elderly adults, and people with disabilities.

 

Self-Pay:

Individuals who directly bear the cost of healthcare services without the involvement of a third-party payor, often applicable to those without insurance coverage.

 

Premium:

The amount paid by individuals or employers for health insurance coverage, typically on a monthly basis, influencing the financial relationship between the insured and the payor.

 

Co-payment (Co-pay):

A fixed amount paid by the insured at the time of receiving healthcare services, often determined by the insurance plan and shared between the patient and the payor.

 

Deductible:

The amount an insured individual must pay out-of-pocket before the insurance coverage begins contributing to the cost of healthcare services.

 

Coinsurance:

A cost-sharing arrangement where the insured pays a percentage of the total cost of healthcare services, with the remaining percentage covered by the payor.