Health care provider: This is any person who provides care to a patient, from a physician to a bedside aide. In the eyes of an insurance company, a health care provider can also be an institution, like an HMO or a hospital.
HMO: This is the acronym for “health maintenance organization.” An HMO is a group that provides health care under the definition of managed care. An HMO can consist of doctors in their own private practices who are spread out over a city or region, or it can be one general office where all the health care providers are in one location. The HMO can be owned and operated by an insurance company, hospital, union, private corporation, or other group.
Managed care: This is a system in which the people and companies that pay for health care—the patients and the insurance companies—and the providers of health care—doctors, nurses, and the hospital—cooperate to provide quality care while working to keep medical costs down.
Point of service (POS): This is any service that’s provided in a physician’s private office.
Preferred physician organization (PPO): This is a group of private physicians who agree to participate with a given insurance company. They are usually on a fee-for-service basis. A PPO is frequently established by a hospital to link its entire staff of physicians with one insurance carrier.
Primary care physician (PCP): A primary care physician can be a generalist, internist, family practitioner, pediatrician, and, in some cases, an OB/GYN. In other words, a primary care physician is a health care provider who is the first person a patient will see before being referred to a specialist.
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