Types of Insurance Payers
Commercial insurance companies are for-profit entities that sell health insurance to employers and individuals. Major commercial payers include Aetna, Cigna, UnitedHealthcare, and Humana. These companies offer various plan types and negotiate contracts with healthcare providers to establish network rates and payment terms.
Private insurers like Blue Cross Blue Shield operate as independent, affiliated companies across different regions. While they share brand identity and certain operational standards, each BCBS plan operates independently with its own policies and procedures. In many states, BCBS also serves as the Medicare Administrative Contractor, processing Medicare claims on behalf of CMS.
Government Payers
Government payers include:
- Medicare (federal health insurance for people 65 and older and those with certain disabilities)
- Medicaid (joint federal-state program for low-income individuals)
- TRICARE (health coverage for military personnel and their families)
Each government program has specific enrollment requirements, covered benefits, and billing procedures.