There are many definitions of healthcare that can be confusing. This information is intended to assist you in understanding the process.
A health plan with exclusive provider organization (EPO), which combines the best of both a HMO/PO, is an EPO. This type of plan can store electronic medical records. You will only need the services of providers in your network. You will be charged more if you require care outside the network. A higher cost share may apply to you.
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. You will only be covered for the services rendered by providers outside your network.
The Patient-as-Partner Approach is a way to engage 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. A patient might choose to consult with a doctor by phone or get a second opinion.
Electronic Medical Records (EMRs), which are computerized systems that store all clinical data, are called electronic medical records. They are typically used to monitor and record your health care, with a deductible or 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. Behavioral healthcare can also be provided in ambulatory care centers and hospitals.
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.
Insurers may review your claims prior to paying them. If the claim meets the required standards, the insurer will reimburse you. You may need preauthorization for some insurance plans before you are eligible to receive certain procedures.
HIPAA is the Health Information Privacy Act. It establishes standardized security standards to allow the exchange of sensitive information. It is enforced by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.
The Affordable Care Act (ACA) requires most health plans to provide four basic levels of coverage. These levels depend on your household's income, dependents, and government assistance.
Your annual healthcare deductible is the maximum you can pay for each year. Your deductible will limit the amount you can spend on healthcare if you are in an accident or have a serious illness. This does not include visits to hospitals or doctors out of network. 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.