Financial Glossary

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Term Definition
Patient Representative A hospital employee paid to assist and advocate for patients who encounter problems with their care.
Payer A person or organization which pays the hospital for services rendered to patients. This can be the patient and/or third parties such as Medicare or other private insurance plans.
Payment Plan A financial agreement between a patient and a financial counselor or other representative of the provider’s office prior to initiating treatment. Individual terms apply at the discretion of the practice.
Pre-authorization A determination made by an insurance carrier prior to the provision of services that the services are medically necessary and covered under the benefit plan.
Preferred Provider Organization (PPO) An insurance organization that contracts with medical care providers to provide health care services to their members at lower-than-usual fees in return for prompt payment. If a patient wants to receive services outside the PPO network, the PPO will limit coverage.
Premium The amount an insured individual pays to purchase insurance and keep it active.
Primary Insurance A third-party payer identified as having primary responsibility for payment of charges.
Provider An individual or institution which gives medical care. Institutional providers include a hospital, skilled nursing facility and intermediate care facility. Individual providers include individuals (physicians, dentists, etc.) whose primary activity is the provision of health care to individuals.