It can sometimes be difficult to understand healthcare terminology. The following information will help you to navigate this 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. You will only need the services of providers in your network. If you need to see a provider outside of your network, you may be charged more. A higher cost share may apply to you.
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 services provided if you see a provider not in the network.
The Patient as Partner Approach is a way to involve patients in the healthcare system. 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. A patient might choose to consult with a doctor by phone or get a second opinion.
Electronic Medical Records (EMRs) are computerized systems that store all your clinical data. They are typically used to monitor and record your health care, with a deductible or copayments.
Behavioral Healthcare refers specifically to a range treatment options for substance abuse or mental illness. Counseling and medication management are two examples. Behavioral healthcare can be offered in both hospital emergency rooms and ambulatory care facilities.
Electronic prescribing is a way for pharmacies to electronically share patient information. Electronic prescribing is a method that transfers prescription information from a doctor's office to a pharmacy using computerized systems.
Your claims may be reviewed by insurance companies before being paid. If your claim meets the requirements, the insurer will reimburse. Preauthorization and precertification are required for certain insurance plans.
HIPAA (Health Information Privacy Act) seeks to establish standard security standards for sensitive information exchange. It is enforced at the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable Care Amendment (ACA) requires that most health plans offer four basic levels 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. Non-covered services such as visits to hospitals or doctors not in your network are not covered. 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 funds to pay for any healthcare expenses your plan 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.