Agreement between the patient and a doctor, podiatrist, dentist, or optometrist who has decided not to offer services through the Medicare program. This doctor cannot bill Medicare for any service or supplies given to the patient and all his or her other Medicare patients for at least 2 years. There are no limits on what the patient can be charged for the services under a private contract. The patient must pay the full amount of the bill and submit his or her own insurance claims for reimbursement. The GJ modifier must be used on all insurance claims for services rendered by an “opt out” provider for emergency/urgent services.
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Private duty nursing service
Nursing services by a registered nurse (RN) or licensed practical nurse (LPN) who is not employed by an institution (hospital, home health care agency, skilled nursing facility, or hospice provider) but may work in an institution caring for a patient on a fee-for-service basis. Private duty care also may occur in the home.
Private fee-for-service plan
Medicare Advantage Plan in which the patient may go to any Medicare-approved physician or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what the patient should pay for the medical services.
Private hire vehicle
Passenger seating vehicles having not more than 12 seats and used for the carriage of passengers for hire or reward but, not being authorised to ply for hire from the streets and designated places, are hired direct from the insured’s premises or instructions issued therefrom.
Private hospital
Medical facility that is privately owned and operated by an individual, several people, or a corporation.
Private hotel
A convenient term to distinguish hotels from those run as inns. It is an establishment, which, unlike an inn, picks and chooses its guests. The proprietor’s responsibilities for guests and their property are not governed by any special legal rules. The normal laws of tort, contract and bailment will apply.
Private insurance
Conventional health care coverage bought from an insurance company that allows the insured to select his or her physicians, hospitals, and other health care facilities.
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Voluntary insurance programs available from private firms or from the government by which an individual may obtain protection against the possibility of loss due to a contingency.
Private managed funds
A normal insured pension but having a fund link that is unique to the individual or partners in a business. The life insurance company owns the assets of the funds which are therefore subject to regulatory control so the individual cannot manage the fund as can happen with self-investment personal pensions.
Private medical attendant’s report
See: medical attendant’s report.
Private medical insurance
1. Insurance that enables the insured to gain access to medical treatment, with benefits including: a private en-suite room in hospital; surgeon’s and other specialists’ fees; out-patient treatment, including physiotherapy; day care treatment, including diagnostic and surgical procedures. 2. An integral part of a typical travel insurance.