It can sometimes be difficult to understand healthcare terminology. To help you understand the process, we have compiled the following information.
An EPO (exclusive provider organization) is a combination of features from a HMO or a PPO. This type of plan stores medical records electronically. Therefore, you will only need access to providers within your network. If you need care outside of the network, you will pay more. You may also be subject to a higher cost share.
A health maintenance program (HMP), a type or insurance plan that covers all medical costs including deductibles and copayments, is called a health maintenance program. Your benefits are not tied to your network, unlike a PO. If you go to a provider outside the network, your insurance will not cover the actual cost of services.
The Patient-asPartner Approach is a way for patients to be involved in the healthcare process. It recognizes the importance of the patient's experience knowledge as well as the scientific knowledge of the HCP. Patients are encouraged to take part in their own care. One example is that a patient could choose to have a second opinion or talk with a doctor via the telephone.
Electronic Medical Records (EMRs) are computerized systems that store all your clinical data. These records are used to record and monitor your healthcare, and include a copayment and deductible.
Behavioral healthcare is a term that refers to a range of treatment options for substance and mental abuse. These include counseling and medication control. You can find ambulatory or hospital-based behavioral healthcare.
Electronic prescribing allows pharmacies to share patient information electronically. E-prescribing uses computerized systems to transfer prescription information from a physician's office to a pharmacy.
Insurers might review your claims before they pay them. The insurer will reimburse you if the claim meets certain standards. You may need preauthorization for some insurance plans before you are eligible to receive certain procedures.
HIPAA, also known as the Health Information Privacy Act (or HIPAA), seeks to establish security standards that allow for the safe exchange of sensitive data. It is enforced at the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable Health Care Act (ACA), which requires all health plans to offer coverage, requires four levels. These levels vary based on your household's income, number of dependents, and the level of assistance that the government provides.
Your healthcare costs for the calendar year are limited by your annual deductible. 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 apply to services that aren't covered, such as visits at hospitals and doctors outside your network. Also, if you are hospitalized, your deductible only applies to the amount you spend for care during the time 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.