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Billing and Revenue

A third-party payer manages healthcare expenses for the insured (patient) and other covered parties and provides reimbursement for treatment and services covered under a contractual agreement between the insured and the payer. Several examples of third-party payers include HMOs, PPOs, Medicare, and Workers’ Compensation. Select two of the third-party payers to compare and contrast based on your readings.

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Consider in your discussion the differences and similarities in access to providers, choice of provider, out-of-pocket costs to the patient such as required co-pays and coinsurance and deductibles, and appeals for denied services. Identify based on your comparisons which type of plan you would prefer as a patient and why.


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