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Language Foundation

preferred provider

A preferred provider is a doctor, hospital, or other health care provider that has a contract with a health plan to provide covered services to plan members at agreed rates as part of the plan's network.

In plain English

A health plan places a provider in its network after making a contract with that provider. The contract sets agreed rates for covered care for the plan's members.

In context

Here, the term classifies a clinician or facility as a provider in the health plan's network under contract to provide covered services to plan members at agreed rates.

Situation
Checking provider networks, authorization, referrals, eligibility, and preapproval states
What it communicates
classifies a clinician or facility on network comparison materials.

Meaning limits

The term alone does not establish that any particular service from that provider is covered.

Examples

“After the hospital signed a contract with the health plan to treat members at agreed rates, it became a preferred provider.”

Core meaning

“Before booking the procedure, she checked whether the surgeon was a preferred provider in her health plan's network.”

In context

  • health care provider Broader Term

    A preferred provider belongs to this larger category.

  • out-of-network provider Contrast

    This contrasts with a provider that is not part of the plan's network.