It can sometimes be difficult to understand healthcare terminology. Luckily, the following information has been compiled to help you navigate the process.
An exclusive provider organization (EPO) is a health plan that combines features of a HMO and a PPO. This plan electronically stores your medical records. This allows you to only see providers within your network. If you have to seek care outside the network, you'll be charged more. You might also be charged a higher cost sharing.
A health maintenance programme (HMP) covers all medical expenses. This includes deductibles, coinsurance, as well as copayments. Your benefits are not dependent on who you see, unlike a PPO. Your insurance will only cover the cost of services rendered if you visit a provider that is not part of your network.
The Patient as a Partner Approach is a way of engaging patients in the healthcare process. It recognizes that the patient's personal experience is just as important than the HCP's scientific information. Patients are encouraged and supported to take an active part in their care. The patient can, for example, get a second opinion from a doctor or consult with one over the phone.
Electronic Medical Records (EMRs are computerized records that store all of your medical data. They are usually used to record and monitor your care, including a deductible and copayments.
Behavioral healthcare is a term that refers to a range of treatment options for substance and mental abuse. These include counseling and medication control. Both ambulatory and hospital emergency rooms can offer behavioral healthcare.
Electronic prescribing allows pharmacies and doctors to electronically share patient data. Electronic prescribing is a method that transfers prescription information from a doctor's office to a pharmacy using computerized systems.
Insurers might review your claims before they pay them. If the claim meets the required standards, the insurer will reimburse you. Some insurance plans require you to precertify or authorize before you can receive specific procedures.
HIPAA (Health Information Privacy Act) seeks to establish standard security standards for sensitive information exchange. It is enforced through the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable Care Act (ACA) requires most health plans to provide four basic levels of coverage. These levels will vary depending on the income of your household, the number of dependents and the amount of government assistance.
Your annual deductible covers your healthcare costs for the entire year. If you have an accident, or are diagnosed with a major illness, your annual deductible caps the amount of healthcare you can afford before your insurance kicks in. This does not include visits to hospitals or doctors out of network. Your deductible does not apply to hospitalizations. It only covers the cost of care you receive while you are there.
You can also use your HSA health savings account to cover healthcare expenses that your health insurance doesn't cover. HSAs, which are tax-advantaged savings accounts, can be used by you to pay for services that aren't covered by your health insurance.