It can sometimes be difficult to understand healthcare terminology. This information is intended to assist you in understanding the process.
An EPO (exclusive provider organization) is a combination of features from a HMO or a PPO. This type plan stores electronic medical records. This means that you only need to visit providers within your network. You will be charged more if you require care outside the network. You could also be subject to a higher price share.
A health maintenance programme (HMP) covers all medical expenses. This includes deductibles, coinsurance, as well as copayments. Your benefits are not tied to your network, unlike a PO. If you go to a provider outside the network, your insurance will not cover the actual cost of services.
The Patient-asPartner Approach is a way for patients to be involved in the healthcare process. It recognizes that the patient's personal experience is just as important than the HCP's scientific information. It encourages patients to be involved in their own healthcare. 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 systems that store all your clinical data. They are often used to track and monitor your care.
Behavioral healthcare covers a wide range of treatments for substance abuse and mental disorders. 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. E-prescribing uses computerized systems to transfer prescription information from a physician's office to a pharmacy.
Before paying you, insurers may review your claims. The insurer will reimburse you if the claim meets certain standards. 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 administered 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 are determined by your household's income and dependents as well as the assistance provided by the government.
Your annual deductible caps your healthcare costs for the year. Your deductible limits how much healthcare you can pay before your insurance kicks into effect, such as if there is an accident or major illness. Non-covered services such as visits to hospitals or doctors not in your network are not covered. 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 health savings account to cover healthcare expenses that your health insurance doesn't cover. HSAs are tax-advantaged savings account that can be used for healthcare services not covered by your plan.