P

Paid to Provider Amount the insurance company pays your medical provider.

Paid to You -Amount the insurance company pays you or your guarantor.

Participating Provider- When the doctor or hospital agrees to accept your insurance payment for covered services as payment in full, minus your deductibles, co-pays and coinsurance amounts.

Patient Amount Due-The amount charged by your doctor or hospital that you have to pay.

Patient Type -A way to classify patients--outpatient, inpatient, etc.

Pay This Amount -How much your bill says you have to pay.

Per Diem-Charged or paid by the day.

Pharmacy Charges- Cost of drugs given under a pharmacist’s direction.

Physical Therapy –Treatment of diseases or injuries by exercise, heat, light, and/or massage.

Physician - Person licensed to practice medicine.

Physician Extenders -Also called mid-level service providers. Physician extenders include licensed nurse practitioners and/or licensed physician assistants. They coordinate patient care under a doctor’s supervision.

Physician Office - Your doctor’s office.

Physician Practice –A group of doctors, nurses, and physician assistants who work together.

Physician Practice Management -Non-physician staff hired to manage the business aspects of a physician practice. These staff includes billing staff, medical records staff, receptionists, lab and X-ray technicians, human resources staff, and accounting staff.

Point-of-Service Plan (POS) - An insurance plan that allows you to choose doctors and hospitals without having to first get a referral from your primary care doctor.

Policy Number-A number that your insurance company gives you to identify your contract.

Pre-Admission Approval or Certification-An agreement by your insurance company to pay for your medical treatment. Doctors and hospitals ask your insurance company for this approval before providing your medical treatment.

Pre-Existing Condition -A health condition or medical problem that you already have before you sign up to receive insurance. Some health insurers may not pay for health conditions you already have.

Prepayments - Money you pay before getting medical care; also referred to as preadmission deposits.

Prevailing Charge -A billing charge that is commonly made by doctors in a specific region or community. Your insurance company determines this charge.

Primary Care Network (PCN) -A group of doctors serving as primary care doctors.

Primary Care Physician (PCP) -A doctor whose practice is devoted to internal medicine, family/general practice, or pediatrics. Some insurance companies consider Obstetrician/gynecologists primary care physicians.

Primary Insurance Company -The insurance company responsible for paying your claim first. If you have another insurance company, it is referred to as the Secondary Insurance Company.

Private Room (Deluxe) –A more expensive hospital room than those available to other patients. You must pay extra for this type of room.

Procedure Code (CPT Code)- A code given to medical and surgical procedures and treatments.

Prospective Payment System (PPS)- A Medicare system that pays hospitals a set amount for covered diagnostic or treatment services.

Provider Contract Discount -A part of your bill that your doctor or hospital must write off (not charge you) because of billing agreements with your insurance company.

Provider Name, Address, and Phone # -Name and address of the doctor or hospital submitting your bill.

Psychiatric/Psychological Treatments- Nursing care and other services for emotionally disturbed patients, including patients admitted for inpatient care and those admitted for outpatient treatment.