A company, organization, or a subsidy of a government department that agrees to pay for all or a part of its members' medical care is referred to as a payer.

Health Care Insurance Services

A company, organization, or a subsidy of a government department that agrees to pay for all or a part of its members' medical care is referred to as a payer. Medicare and CHAMPUS (Civilian Health and Medical Programs of the Uniformed Services) are federal government payers. To qualify for Medicare, a person has to be at least 65 years old and be receiving retirement or disability benefits from Social Security. CHAMPUS health benefits, for both active and retired military personnel, also cover eligible dependents. Medicaid, created to provide medical care to low-income families, is funded by the government as well, but it is managed by each state independently.

To quality for health insurance, a person pays a monthly premium and has an annual deductible, depending on the plan selected. Generally, there are no deductibles for persons enrolled in health maintenance organizations (HMOs), but members usually have to make a co-payment at the time of service.

Patient eligibility and insurance coverage should be verified as soon as possible at the time of service. With today’s medical management software, verification can be done even before any services have been provided.

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