What is a provider?
Provider is a term used to refer to a medical professional or medical facility. It encompasses a wide range of professionals, including doctors, nurse practitioners, physical therapists, pharmacists, etc. as well as a wide range of facilities such as hospitals, clinics, pharmacies, surgery centers, etc.1
Most health insurance plans contract with a network of providers. Plan enrollees pay lower out-of-pocket costs if they use those in-network providers, and some health plans will only cover care that’s received from an in-network provider.
Note that a health plan pays providers, but the health plan is not a provider itself.
Footnotes
- ”Health Care Provider Definition and Cross-Reference Table” The Office of the National Coordinator for Health Information Technology. Accessed Oct. 9, 2024 ⤶
