US Healthcare System Overview

The U.S. health care system is the best health care system in the world, pointing to the freely available medical technology and state-of-the-art facilities that have become so highly symbolic of the system. So we will try to get a basic level understanding about the U.S. healthcare system. Find the below list of main entities of U.S. healthcare:- 
  • Healthcare Provider/Doctor/Hospital/Facility,
  • Health Insurance Provider/Payer, 
  • Member/Subscriber
  • Group and 
  • Federal and State Governments
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U.S. Healthcare Terminology

  • Health Insurance: It will be a contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.
  • Insurer/Payer: The insurance company whose plan pays to help cover the cost of your care.
  • Primary Insurer: The insurance plan that processes the claim first when a  member has more that one group insurance plan covering the services.
  • Healthcare ProviderIt can be any person (doctor or nurse) or institution (hospital, clinic or laboratory) that provides medical care.
  • Member/SubscriberA person who is enrolled in a health plan (also called an enrollee or subscriber)
  • Group: It can be a Employer, Group Insurance
  • PlanAn individual or group plan that provides, or pays the cost of medical care.

How does the american healthcare system work

The below pictorial representation demonstrates you about how U.S. healthcare system works in united states of america :- 
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*EOB: Explanation of Benefits, which is statement of insurer that itemizes how benefits were approved or denied for a claim.

I hope you will enjoy this article about US Healthcare Domain Knowledge. I would like to have feedback from my blog readers. Your valuable feedback, question, or comments about this article are always welcome. Also If you like this article, don't forget to share this article with your friends and colleagues.
US Healthcare System Overview Reviewed by Ravi Kumar on 1:10:00 AM Rating: 5

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