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The difference between a healthcare provider's stated charge and the payment agreed to with a third-party payer (such as an insurance company) is called: Contractual allowance.
- Any payment for medical care made by a party other than the patient is referred to as a "third-party payment."
- It could be either a public or private organization.
- Instead of paying insurance premiums, the government pays healthcare providers with money gained from the taxes paid by existing workers.
- The payer, an insurance company or health agency that is not directly involved in the patient's care and pays the doctor, clinic, or other second-party provider for the treatment or services provided to the first party is the third party (patient).
What is contractual allowance?
The difference between what a healthcare provider bills for the service rendered and what it will contractually be paid (or should be paid) based on the terms of its contracts with third-party insurers and/or other third parties is known as a contractual allowance, also known as a contractual adjustment.
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