Definitions of healthcare terms can sometimes be confusing. Luckily, the following information has been compiled to help you navigate the process.
An exclusive provider organization (EPO) is a health plan that combines features of a HMO and a PPO. This type of plan stores medical records electronically. This allows you to only see providers within your network. You'll pay more for care outside your network. You might also be charged a higher cost sharing.
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 a Partner Approach is a way of engaging patients in the healthcare process. It recognizes that the patient's personal experience is just as important than the HCP's scientific information. 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 are computerized records that store all of your medical data. They are used to monitor and record your care, as well as copayments and deductibles.
Behavioral Healthcare refers specifically to a range treatment options for substance abuse or mental illness. These include counseling, medication management, and other options. 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.
Your claims may be reviewed by insurance companies before being paid. If the claim meets all requirements, the insurer may reimburse you. Preauthorization and precertification are required for certain insurance plans.
HIPAA, or the Health Information Privacy Act, aims to create standardized security standards for sharing sensitive information. It is enforced jointly by 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 caps your healthcare costs for the year. For instance, if you have an accident or suffer from a major illness, your deductible limits the amount of healthcare that you can spend before your insurance kicks in. 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 can be used to cover healthcare costs that are not covered by your insurance.