Private Payers Coverage
Private payer coverage for drugs and services
varies by the specific payer, the plan, and the benefit type. It is important to understand patient-specific
benefits and coverage guidelines that may apply to the service being
provided to the patient. You can call
Private Payer Payment
Private payers employ various payment methodologies but often pay for services based on mechanisms like contracted rates, capitation, or percent of charges. Payment for drugs may be based on average wholesale price (AWP), wholesale acquisition cost (WAC), invoice cost, average sales price (ASP), or a percentage of Medicare. Depending on the payment methods used by the payer, providers may or may not receive separate payment for physician-administered drugs in addition to services provided. It is important to know what is in your payer contracts so you know how payers will pay your practice or facility for drugs and services you provide to patients.
