What Are Healthcare Providers?

People have heard the term health care provider at some point, either through health care appointments or through insurance discussions. Health care providers are obligated to follow specific rules and regulations regarding confidentiality and services. Individuals should know whether specific businesses are health care providers to fully understand what is expected by law.

Definition

• A health care provider, according to the Department of Health and Human Services, is a provider of services, which may include physician treatment, treatment by those who work in conjunction with a physician, or diagnostic care. People that work with a physician, such as nurses, specialists, nurse aides, assistants and billing representatives are all included within the health care scope. The definition set forth by the Department of Health and Human Services offers a consistent definition that is utilized by regulating state and federal agencies, insurance organizations and providers themselves.

Types

• UC Berkeley outlines that physicians that practice in areas such as general health, podiatry, osteopathy, chiropractic, dentistry, optometry, psychiatry, social work or clinical medicine are considered health care providers. Examples of others that would fall under a physician's umbrella of care would include the following people in this scenario:

  A patient goes to the doctor because of chest pains. The nurse first assesses the patient by completing vital signs and asking important health information. The doctor then sees the patient. The doctor is unsure of the cause of pain and sends the patient for X-rays. The patient goes to the laboratory and has an X-ray completed by an X-ray technician, as well as blood drawn by a laboratory specialist. The doctor may also have a short evaluation completed by a social worker to determine if stress or anxiety is a culprit. Finally, the patient is prescribed medication for a pulled chest muscle and checks out of the physician's office by paying a bill with the billing specialists. After the patient leaves, transcriptionists will transcribe the services provided and file the notations within the patient's medical history chart. The nurse, physician, laboratory specialists, social worker, billing department workers and transcriptionist all play significant roles within the one health care provider entity.

Organizations

• Health care organizations like hospitals or medical clinics are called health care providers. The Department of Health and Human Services states that any organization affiliated with approved health care providers, such as physicians, are included in the definition of a health care provider. Common organizations that fall under health care providers include hospitals, clinics, home health care businesses and specialty clinics, such as a chiropractor, dentist, optometrist or rehabilitation entity.

Warning

• Health care providers are regulated by state and federal rules and guidelines to provide safe, consistent and private care. Patients should check licensing information on providers they choose. According to state and federal rules, licenses must be posted for patient information. Understanding what is considered a health care provider and what is not included is useful for insurance and health coverage questions. Many insurance companies offer definitions or glossaries that describe terms that are coupled with health care provider "lingo" that may be useful to the patient when looking for services.