Healthcare definitions can be confusing at times. The following information will help you to navigate this process.
A unique provider organization (EPO), a type of health plan, is one that combines both the features of a HMO with a PPO. This type plan stores electronic medical records. Therefore, you will only need access to providers within your network. If you have to seek care outside the network, you'll be charged more. You may also be subject to a higher cost share.
A health maintenance programme (HMP) covers all medical expenses. This includes deductibles, coinsurance, as well as copayments. 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-as-Partner Approach is a way to engage patients 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. For example, a patient may choose to get a second opinion or consult with a doctor over the phone.
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 options include counseling and medication administration. You can find ambulatory or hospital-based behavioral healthcare.
Electronic prescribing allows pharmacists to electronically share patient records. Electronic prescribing allows prescription information to be transferred electronically from a doctor's practice to a pharmacy via computerized systems.
Insurers may review your claims prior to paying them. If the claim meets these standards, the insurance company will reimburse you. You may need preauthorization for some insurance plans before you are eligible to receive certain procedures.
HIPAA (Health Information Privacy Act) seeks to establish standard security standards for sensitive information exchange. It is enforced jointly by 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 are determined by your household's income and dependents as well as the assistance provided by the government.
Your annual healthcare deductible is the maximum you can pay for each year. Your deductible limits how much healthcare you can pay before your insurance kicks into effect, such as if there is an accident or major illness. However, this does not include non-covered services, such as visits to non-network doctors and hospitals. You will only be liable for the actual amount of the care you receive when you are in hospital.
You can also use your HSA health savings account to cover healthcare expenses that your health insurance doesn't cover. HSAs are tax-advantaged savings accounts that can be used to pay for healthcare services that are not covered by your health plan.