Healthcare definitions can be confusing at times. To help you understand the process, we have compiled the following information.
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. This means that you only need to visit providers within your network. You'll pay more for care outside your network. You could also be subject to a higher price share.
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. However, unlike a PPO your benefits do not depend on your network. You will only be covered for the services rendered by providers outside your network.
The Patient as Partner Approach is a way to involve patients in the healthcare system. It recognizes that the patient's personal experience is just as important than the HCP's scientific information. Patients are encouraged to take part 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 (EMR) are computerized systems that store all of your clinical data. These records are used to record and monitor your healthcare, and include a copayment and deductible.
Behavioral healthcare refers to a variety of treatment options for mental and substance abuse. These options include counseling and medication administration. Behavioral healthcare can be offered in both hospital emergency rooms and ambulatory care facilities.
Electronic prescribing is a way for pharmacies to electronically share patient information. 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 these standards, the insurance company will reimburse you. Some insurance plans require preauthorization or precertification before you can 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 Care Amendment (ACA) requires that most health plans offer four basic levels coverage. These levels depend on your household's income, dependents, and government assistance.
Your healthcare costs for the calendar year are limited by your annual deductible. 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. However, this does not include non-covered services, such as visits to non-network doctors and hospitals. You will only be liable for the actual amount of the care you receive when you are in hospital.
You can also use your HSA health savings account to cover healthcare expenses that your health insurance doesn't 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.