It can sometimes be difficult to understand healthcare terminology. We have provided the following information to assist you with your understanding of the process.
An EPO is an exclusive provider organization, which is a plan that offers both a HMO (prescription only) and a PPO (prescription only). This type plan stores electronic medical records. This allows you to only see providers within your network. You'll pay more for care outside your network. You could also be subject to a higher price share.
A health maintenance plan (HMP), is a type insurance program that covers all medical expenses, including coinsurance and deductibles. However, unlike a PPO your benefits do not depend on your network. 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-Partner Approach is a way to engage patients in the healthcare process. It acknowledges that the patient's experiential knowledge is just as important as the scientific knowledge that the HCP has. In addition, it encourages patients to take an active role 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), which are computerized systems that store all clinical data, are called electronic medical records. 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, medication management, and other options. You can find ambulatory or hospital-based behavioral healthcare.
Electronic prescribing allows pharmacies electronically to share patient information. Electronic prescribing utilizes computerized systems that transfer prescription information from a physician to a pharmacist.
Before paying you, insurers may review your claims. The insurer will reimburse you if the claim meets certain standards. Certain insurance policies require precertification or authorization before you can receive certain services.
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 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 healthcare costs for the calendar year are limited by your annual deductible. Your deductible will limit the amount you can spend on healthcare if you are in an accident or have a serious illness. Non-covered services such as visits to hospitals or doctors not in your network are not covered. If you are hospitalized, your maximum deductible is the amount that you pay for care while you are there.
Finally, your HSA (health savings account) allows you to use your money to pay for healthcare costs that your insurance does not cover. HSAs are tax-advantaged savings account that can be used for healthcare services not covered by your plan.