There are many definitions of healthcare that can be confusing. This information is intended to assist you in understanding 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 of plan can store electronic 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. There may be 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. When you see a provider outside of the network, your insurance will cover only the costs for services provided.
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. Patients are encouraged and supported to take an active part in their care. Patients may also be able to call a doctor and get a second opinion.
Electronic Medical Records (EMR) are computerized systems that store all of your clinical data. They are used to monitor and record your care, as well as copayments and deductibles.
Behavioral healthcare refers to a variety of treatment options for mental and substance abuse. These include counseling, medication management, and other options. In both hospitals emergency rooms and ambulatory healthcare facilities, behavioral healthcare is available.
Electronic prescribing allows pharmacies electronically to share patient information. E-prescribing uses computerized systems to transfer prescription information from a physician's office to a pharmacy.
Before they pay you, insurance companies may review your claims. If the claim meets these standards, the insurance company will reimburse you. Some insurance plans require you to precertify or authorize before you can receive specific procedures.
Similarly, HIPAA, the Health Information Privacy Act, seeks to establish standardized security standards for the exchange of sensitive information. It is enforced jointly by the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable Health Care Act (ACA), which requires all health plans to offer coverage, requires four levels. These levels will vary depending on the income of your household, the number of dependents and the amount of government assistance.
The annual deductible limits your healthcare expenses 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. This does not apply to services that aren't covered, such as visits at hospitals and doctors outside your network. Your deductible does not apply to hospitalizations. It only covers the cost of care you receive while you are there.
You can also use your HSA funds to pay for any healthcare expenses your plan doesn't cover. HSAs can be used to cover healthcare costs that are not covered by your insurance.