By Healthcare Brew Staff
less than 3 min read
Definition:
Payers are the organizations like health insurance plans, Medicare, and Medicaid that handle financial matters, including processing insurance claims, paying provider claims, and handling payments. Some of the big-name insurance companies are Elevance Health (formerly Anthem), Cigna, Humana, Centene, Blue Cross Blue Shield, Aetna, and UnitedHealth Group.
What are the different types of payers?
There are three different types of payers: government/public, commercial, and private.
Government entities include programs like Medicare, Medicaid, and the Children’s Health Insurance Program, and are intended to help certain parts of the population at differing income levels afford healthcare.
Commercial payers are the publicly traded companies that offer health plans people can enroll in through an employer or directly through an insurance marketplace. Private companies operate similarly, but are not required to disclose earnings or other financial details publicly.
What are payers’ role in healthcare?
While the most obvious thing payers do is provide beneficiaries with coverage for various services and procedures, they also impact facilities.
Without payers, patients would be required to pay the full cost of their care, and providers might experience more payment issues, like delayed or unpaid bills, for services they’ve provided. Payers also help provide a balance between cost of care and the quality of that care.
