a key aspect to keep in mind when discussing a payment system we are talking about how a provider is paid by a third party such a medicare or insurance. it is not how a patient pays a physician. the patient piece is the copay that is dictated by their insurance what. what we are talking about this week is how the provider is paid the balance beyond the copay. this perspective will go a long way to helping everyone comprehend what we are discussing and how it affects the provider