It can sometimes be difficult to understand healthcare terminology. We have provided the following information to assist you with your understanding of 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 will not be dependent on the network you have, unlike a PPPO. If you go to a provider outside the network, your insurance will not cover the actual cost of services.
The Patient-as-Partner Approach is a way to engage patients in the healthcare process. It acknowledges that the patient's experiential knowledge is just as important as the scientific knowledge that the HCP has. 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 systems that store all your clinical data. They are used to monitor and record your care, as well as copayments and deductibles.
Behavioral healthcare covers a wide range of treatments for substance abuse and mental disorders. Counseling and medication management are two examples. Behavioral healthcare can also be provided in ambulatory care centers and hospitals.
Electronic prescribing allows pharmacists to electronically share patient records. Electronic prescribing is a method that transfers prescription information from a doctor's office to a pharmacy using computerized systems.
Insurers might review your claims before they pay them. If your claim meets the requirements, the insurer will reimburse. Certain insurance policies require precertification or authorization before you can receive certain services.
HIPAA (Health Information Privacy Act) seeks to establish standard security standards for sensitive information exchange. 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 covers your healthcare costs for the entire year. Your deductible will limit the amount you can spend on healthcare if you are in an accident or have a serious illness. Non-covered services such as visits to hospitals or doctors not in your network are not covered. 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 can be used to cover healthcare costs that are not covered by your insurance.