It can sometimes be difficult to understand healthcare terminology. To help you understand the process, we have compiled the following information.
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 of plan can store electronic medical records. As a result, you will only need to see providers in 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 will not be dependent on the network you have, unlike a PPPO. Your insurance will only cover services provided if you see a provider not in the network.
The Patient-as-Partner Approach is a way to engage patients in the healthcare process. It acknowledges the value of the patient’s experiences as much as the HCP’s scientific knowledge. Patients are encouraged and supported to take an active part in their 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. They are used to monitor and record your care, as well as copayments and deductibles.
Behavioral health refers to a variety treatment options for mental or substance abuse. These include counseling and medication control. In both hospitals emergency rooms and ambulatory healthcare facilities, behavioral healthcare is available.
Electronic prescribing allows pharmacists to electronically share patient records. Electronic prescribing utilizes computerized systems that transfer prescription information from a physician to a pharmacist.
Insurers may review your claims prior to paying them. If the claim meets these standards, the insurance company will reimburse you. Some insurance plans require preauthorization or precertification before you can receive certain procedures.
HIPAA (Health Information Privacy Act) seeks to establish standard security standards for sensitive information exchange. It is administered by the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable Care Act (ACA), requires that all health plans provide coverage at four levels. These levels can vary depending on income, dependents, as well the government's assistance.
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 include visits to hospitals or doctors out of network. 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 funds to pay for any healthcare expenses your plan 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.