Definitions of healthcare terms can sometimes be confusing. The following information will help you to navigate this process.
A health plan with exclusive provider organization (EPO), which combines the best of both a HMO/PO, is an EPO. This plan stores electronic records of your medical information. As a result, you will only need to see 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 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. When you see a provider outside of the network, your insurance will cover only the costs for services provided.
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. Patients may also be able to call a doctor and 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 and medication control. Behavioral healthcare can also be provided in ambulatory care centers and hospitals.
Electronic prescribing allows pharmacies electronically to share patient information. 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. The insurer will reimburse you if the claim meets certain standards. 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 through the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable Care Act (ACA) requires most health plans to provide four basic levels of coverage. These levels vary based on your household's income, number of dependents, and the level of assistance that the government provides.
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. This does not apply to services that aren't covered, such as visits at hospitals and doctors outside your 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, which are tax-advantaged savings accounts, can be used by you to pay for services that aren't covered by your health insurance.