Tuesday, August 5, 2008

Payer vs Payor

The unfortunate soul who does the paying, what do we call him: payer or payor? Naturally, both spellings are being used, and fairly regularly, so if you're editing and haven't been asked this question before, it's coming.

payer = 40 200 000 hits (wins!)
payor = 1 680 000 hits

Editors often allow the -or spelling precisely because it's so prevalent, but a site-specific advanced Google search of JAMA reveals AMA's preference.

payer = 1240 hits (wins!)
payor = 46 hits

AMA style prefers the Merriam-Webster Collegiate Dictionary, which in turn lists the -or spelling as a nonstandard variant (the one not preferred).

But why? I don't sit on the editorial board at Merriam-Webster, so I can't tell you. What I can tell you is that word formation in English is tricky business. Agent nouns like payer (payor) are formed from verbs (ie, to pay), but you'll notice we don't simply slap an -er or -or suffix on any verb to make a noun. Consider the verb correspond, for example: the agent noun isn't corresponder but correspondent.

Thankfully, there are rules (of a sort) that govern noun formation. For example, the agent-noun suffix -or is added to classical and post-classical Latin nouns to give us author, for example, and actor, confessor, doctor, sponsor, and so on. Latin nouns ending in -ator appear in Modern English with the -or ending, like conqueror, donor, and tailor. Post-classical Latin gave us pacator, meaning paymaster, so it's perfectly reasonable to assume that payor would be the valid form of the Modern English noun.

But what's reasonable is not always right since languages tend to break their own rules. When the noun expresses a pure agent—when there's no implication of office, trade, profession, or function—the -er suffix often wins. How can you be sure? Unfortunately, the precise rule, the clear and unambiguous law you're hoping for, doesn't exist here. The choice of -er or -or for agent nouns is somewhat capricious. Liar, like beggar, is an agent noun that takes neither the -er nor the -or ending, so best practice is to follow whatever your preferred dictionary tells you.

At least for AMA editors, then, the noun form of the verb to pay is payer.


Craig said...

This seriously drives me crazy. I edit compliance policies in my organization and have to use "payor" to keep in line with our other policies. It totally makes my eyes bleed. Thanks a million for this post.

TallHoss said...

Yes, but the law profession prefers "payor." And don't we all want to follow the law?

Bold Copy said...

If the law profession prefers it, then that's how it should be -- for law content. It's not so in the medical industry, and I certainly trust the folks at the AMA. I used to work for a major newspaper that insisted on spelling employee without the last "e" (employe). Killed me. Unusual spellings may help you stand out, but not the way you want to stand out. I always side with the majority.

Karen said...

I work in the insurance billing industry. In general (yes, not always, but in general) we use the term payer to specify a specific person eg.John Doe, and payor to indicate an organization...eg. insurance carrier. I'm guessing that is because the insurance industry likes to follow what the legal industry does.

Jason said...

The use of Google hits is hardly conclusive and only reinforces what I believe the true shift in the spelling is - Microsoft. The phenomenon of Microsoft Word with its spell check to, over time, solidify usage to its embedded grammatical source is not unique to this one word. I was taught in grad school to use payOR, but I see most in my current company using payER simply because it makes the little red line in Microsoft Word go away. This would also explain the higher number of hits in Google since much of what gets published on the internet probably was mindlessly corrected by the author with the default spellcheck process.

Stephen Wilkins said...

Hey Jason,

In graduate school, were you given a reason why [payor] is correct and [payer] incorrect?

You're right, of course, that technology influences language use. You're saying that Microsoft goofed by using [payer] in its dictionary, which, over time, has popularized the incorrect form... right?

I'm not so sure. In front of me now is a 1949 edition of The Consolidated-Webster Encyclopedic Dictionary; like the current Collegiate version I refer to in this post, Consolidated-Webster gives us [payer]. In other words, Webster's been using the -er spelling for over 60 years.

Why is Webster wrong? I'm genuinely interested in whatever explanation you were given in grad school, Jason.

And thanks, sincerely, for taking time to comment.

Lee said...

I agree with Jason, Microsoft is the culprit. Prior to Spellcheck most definitely everyone in the healthcare industry spelled payor with the "o". I remember asking my boss once around 1999, when I was reading something she wrote, why she was suddenly spelling payor with an "e". She said, "because Spellcheck makes you correct it". Huh? The "wrong" is in the fact that Microsoft programmers didn't bother to put payor in the dictionary, and that the sheeple took the word of the software instead of just right clicking and adding payor to the dictionary. The same thing happened with advisor, which is now being spelled adviser, as if advisor just fell off the face of the earth.

Stephen Wilkins said...

Thanks, Lee, for joining the discussion.

In order for Microsoft to be "the culprit" in this case, wouldn't Microsoft need to be guilty of an error? I don't think anyone has yet demonstrated as much.

Now, to be fair, you did say "the 'wrong' is in the fact that Microsoft programmers didn't bother to put payor in the dictionary."

However, suppose [payor] wasn't overlooked but deliberately removed precisely because it is, as Webster says, the nonstandard spelling in 'American' English.

In order to demonstarte Microsoft's guilt, one would need to show, not merely assume, that the [-er] form is incorrect.

ImaCrocheting said...

This used to drive me crazy until I decided I was going to do what I felt comfortable with. I use "payor" every day when filing medical appeals to the insurance companies for payment.

If I owe a bill, I'm the payer.

Payor for corporations, business entities, etc.
Payer for John Q. Public, like myself. :)

Payor Woman said...

I work in the insurance industry also...specifically in contracting... and "payor" is utilized because its the correct legal term. Its appropriate because of the legal documents...the physician/facility contract....that define the relationship between the "payor" and the physician/facility.

Unknown said...

The correct form should be Payor, because there is a Payee. When you have a Lessee you have a Lessor, NOT a Lesser. Microsoft's misspelling spelling program is the culprit for the large number of hits for the wrong spelling.

Stephen Wilkins said...

Thanks for the comment, Unknown.

I never considered whether the -ee ending (where verb + 'ee' = object) might help clarify correct and preferred usage of the -er/-or (subject) ending.

It might be helpful (and would certainly be crazy interesting) to collect examples of -ee object nouns and show them in a table with their corresponding subject forms.

If any of you do so and blog about it, please let us know by sharing a link to your post. I intend to make the table and blog about it, but given present circumstances... could be 2012 by then.

Cheers, everyone, for your comments and feedback!

David Smith said...

My 1925 OED lists "payer" dating to Middle-English and "payor" as an occasional variant, so it's hard to blame this on Microsoft Word. We do have to remember, however, that when it comes to spelling, correctness is context sensitive. Theatre and colour are correct in Canada while pretentious in the USA. :-)

greymatterbath said...

not so sure about the notion of -ee nouns needing to be complemented with an -or counterpart. case in point: employee/employer. personally, however, i prefer payor and since dictionaries consider it at least somewhat acceptable I will be using that form :)

Joel C in Tucson said...


Now, if there were a base/basee, it would probably be basor, as baser has some use (as in more base). English, as you have said, is a serious rule breaker, and probably that is why Francophones despise us, as Anglophones. Also why teaching English as a second language is most difficult!

I love your blog, just found it, and it is a fun spot for an old guy (ex insurance) like me.

Joel C

Stephen Wilkins said...

Thanks, Joel, for your input and kind words.

For what it's worth (very little, I know), I checked 'guarantor' and 'trustor' against 3 Webster sources: (1) a 1943 edition of Webster's Comprehensive Encyclopedic Dictionary, (2) a 1949 edition of the Consolidated-Webster Encyclopedic Dictionary, and (3) the current Collegiate version.

With respect to 'guarantor', they're with you; 'trustor', however, they give as 'truster'.

Teaching English as a second language—yes, difficult—ouch! I'm the father of two young children and find it plenty difficult enough teaching them!

= : )

Thomas Marshall said...

I don't think that anyone is Microsoft bashing; they are simply stating that the dictionary in Microsoft has fueled the shift away from payOR to payER. The dictionary in MS Office is a tool and the tool needs to be customized by using "Add to Dictionary" for "Payor" and "Payors" as did my browser in posting my reply to this site. In the meantime, those of us with substantial experience in healthcare, 17 years in my case usually prefer, as ImaCrocheting states:

Payor for corporations, business entities, etc.
[including private insurance carriers and government entities such as State WC, CMS, etc.]

Payer for John Q. Public, like myself. :)

Jason said...


I don't think it's correct to say Microsoft is the "culprit" or that they did something "wrong" or "incorrect". Rather, they have steered convention. The dictionary indicates both spellings, -or and -er, are both acceptable. And I was taught in graduate school that by convention, the -or usage was more accepted and prevalent when referring to health insurance companies that pay claims because the -er usage had a different nuance. What I was trying to say is that Microsoft and other spell checking mechanisms have steered the convention away from the -or when referring to health insurance companies. I believe this is a direct result over time of thousands of individuals typing the word "payor" into a Word document or email, and seeing a little red line appear under the word. If both spellings are actually acceptable, and Microsoft (or others) didn't want to steer the conventional usage, they wouldn't have made it so that a red line appears when the word "payor" is typed into Word. In fact, I find the most flippant part of the original argument the "evidence" of Google hits - which would imply that because a certain spelling or convention is more prevalent on the Web, it is therefore "correct", or to use the wording of the author - Winner! That is absurd. As an example, what percentage of people correctly use the phrase, "I couldn't care less." It seems to use (without actual measure) that approximately 90% of individuals I hear use this phrase say, "I could care less", which is of course a pointless statement. My point is that a preponderance of usage also does not indicate "correctness" of spelling or grammar.

HCFS, Inc. said...

So glad you have this article. . . thanks for the suggestions!

David said...

Well said, Jason. I, too, learned the same things in graduate school, but having studied grammar for most of my life (son of a graduate school professor and English teacher), always enjoy it when someone else realizes the "preponderance" phenomenon in American English.
I am a healthcare professional, and we in the industry do generally prefer "payor" when referring to entities such as insurance companies and Medicare.

Wilkins said...

Hey Jason, I want to offer a brief response to your last comment from 2012 (obviously, I'm ridiculously late and apologize for losing touch with my blog).

First, with respect to whether "preponderance of usage," generally speaking, indicates "'correctness' of spelling or grammar," I don't think we disagree. For I have not argued that editors applying AMA style should automatically consider correct whatever most people happen to use. Nor have I argued, even more generally, that the most prevalent spelling used on the web is just simply correct by virtue of its being used most often.

My "original argument" you refer to, in fact, is a great deal more specific: AMA style prefers Merriam Webster Collegiate (MWC); MWC prefers "payer" ("payor" is the nonstandard variant); therefore, editors applying AMA style should use "payer." Your comments aren't, as far as I can tell, interacting with my "original argument."

As to Microsoft steering convention, what you've said in your comment from November 27, 2012, doesn't really address my response from August 16, 2011. As early as 1949, at least, Merriam Webster (MW) has "payer." In his comment from November 23, 2011, David Smith generously added that his 1925 Oxford English Dictionary (OED) gives "payer" the primary entry, though it does at least include "'payor' as an occasional variant." He's right. Also, the OED identifies "payer" as "correlative to payee." In short, there's plenty of well-established convention favoring "payer" long before any Microsoft emerged.

Anyway, thanks for the continued interaction, and I apologize, again, for the long silence.

Donnie Pennington said...

Gotta love six year old threads! I have been a healthcare finance professional since 1976. When I started out in healthcare, 'payor' was the absolute norm (at least among hospitals) and the term 'payer' was utterly unknown. Then in 1982 the Uniform Billing Committee came out with the UB-82 hospital billing form which strictly used the term 'payer'. To this day the Uniform Billing Committee website knows only about 'payer' and not 'payor' if you do a search on that site. Personally I resisted this change for years (for it was definitely a change and a shock) but finally gave up after decades of resistance. All of which is to say: the shift from payor to payer has nothing to do with Microsoft (at least in the healthcare finance arena).

Anonymous said...

If this was an issue regarding some type of surgical procedure, or any medical related decision making, it would automatically defer to the medical professional. The ABA does not attempt to interfere in diagnosing patients. The issue being discussed here relates to the spelling of a word. I am unsure why the AMA feels they have any standing whatsoever with regards to this issue. An attorney is an expert in the law, and most are expert writers. I have read countless treatment summaries written by medical professionals, and most contain multiple grammatical errors. Until the legal profession changes the spelling of the word to "payer," I will continue to follow the appropriate spelling. In summary, the AMA has no standing with regards to how to spell a word.

Janice Leesa said...

AAs a part-time scholar and full-time accountant with private school education and master degrees (as well as a little Latin under my belt) I was always taught Payor, is used when a 3rd party is paying on behalf of another; i.e., the obligation is being paid by an agent as the original OP said. However when one is paying something on their own behalf they're deemed the payer. I agree with those that said spell check is influencing the usage stats and those that say we're individually responsible for correcting (teaching) our spell check programs. As most of us know, spell check is not always correct.