Sometimes, healthcare definitions can be confusing. The following information will help you to navigate this 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 stores medical records electronically. 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. You could also be subject to a higher price share.
A health maintenance plan (HMP), is a type insurance program that covers all medical expenses, including coinsurance and deductibles. Unlike a PPO, however, your benefits are not based on your network. When you see a provider outside of the network, your insurance will cover only the costs for services provided.
The Patient as a Partner Approach allows patients to become involved in healthcare. It recognizes the importance of the patient's experience knowledge as well as the scientific knowledge of the HCP. Patients are encouraged to take part in their own care. A patient might choose to consult with a doctor by phone or get a second opinion.
Electronic Medical Records (EMRs are computerized records that store all of your medical data. They are usually used to record and monitor your care, including a deductible and copayments.
Behavioral healthcare covers a wide range of treatments for substance abuse and mental disorders. These include counseling and medication control. 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.
Insurers might review your claims before they pay them. If the claim meets the required standards, the insurer will reimburse you. Preauthorization and precertification are required for certain insurance plans.
HIPAA, or the Health Information Privacy Act, aims to create standardized security standards for sharing sensitive information. It is enforced at the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable care Act (ACA), mandates that health plans must provide basic 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 caps your healthcare costs for the year. For example, if your healthcare costs are high due to an accident or major illness, your deductible can limit how much you can spend on healthcare before your insurance starts. Non-covered services such as visits to hospitals or doctors not in your network are not covered. If you are hospitalized, your maximum deductible is the amount that you pay for care 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 accounts that can be used to pay for healthcare services that are not covered by your health plan.